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
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.
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
4
Q
Infections that require rapid intervention before other therapeutics /diagnostics
A
necrotizing Fasciitis
clostridial myonecrosis
5
Q
possible Etiologies for Septic stock
A
pseudomonas, gram negative enteric bacilli, Staph, Strep
6
Q
purpura fulminans
A
N. meningitidis
7
Q
meningococcemia treatment
A
penicillin/ceftriaxone
8
Q
Toxic Shock Syndrome is caused by
A
GABHS, Staph Aureus
9
Q
Treatment For Acute Bacterial Endocarditis
A
Ceftriaxone+ vancomycin
covering For the Following: S. aureus, HACEK, B -hemolytic Strep, Neisseria sp, S, pneumonia
10
Q
Septic shock patients at risk of adverse outcomes
A
elderly patients with co - morbid, concurrent malignancy and neutropenia, recent surgery/ hospitalization
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)
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
13
Q
pink, blanching, maculapapular(trunk and ext) becoming hemorrhagic, forming petechiae
A
meningococcemia
14
Q
Cutaneous manifestation of DIC
A
purpura Fulminans
15
Q
E cthyma Gangrenosum
A
P. aeruginosa/ Aeromonas hydrophila
16
Q
Focal skin lesions and overwhelming sepsis seen in patients with liver disease is usually caused by
A
vibrio vulnificus
17
Q
causes septic shock in asplenic patients with infection Following a dog bite
A
Capnocytophagia caninormus
18
Q
Sunburn - type rash s usually diffuse, on face, trunk and extremities seen on TSS patients
A
Erythroderma
19
Q
Risk factors For Necrotising Fasciitis
A
bm, PVD, iv drug use
20
Q
Bacterial meningitis is most commonly associated with
A
S. pneumonia, N. meningitidis
21
Q
Predisposing risk factors For Listeria monocytogenes meningitis
A
cell mediated immune deficiency
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
23
Q
Cerebral malaria is caused by
A
Plasmodium Falciparum
24
Q
Jugular septic thrombophiliabitis caused by Fusobacterium necrophorum
A
Lemierre’s disease
25
Vaccines contraindicated For pregnant, Immunocompromised, HIV with CD4<200
MMR, varicella, zoster
26
HPV vaccine given to
| a) Male b) Female
Males HPV 4
| Females: HPV 2 and HPV 4
27
Zoster vaccination
single dose: for adults >/=60 years old regardless of prior episode of Herpes Zoster
28
Indications to Hib vaccine
Anatomical or Functional asplenia
sickle cell disease
undergoing Elective splenectomy( 14 or more days before)
29
Fever> 38.3 on at least 2 occasions > /= 3 weeks no known immunocompromised state and dx remains uncertain after a thorough investigation
Fever of Unknown Origin
30
More common non infectious causes of FUO
```
Large vessel vasculitis
Polymyalgia rheumatica
Sarcoidosis
Familial mediterranean fever
Adult onset Still's disease
```
31
Schnitzler's syndrome
FUO+ Urticaria
Bone pain
Monoclonal gammopathy
32
Most common cancer cause of FUO
Malignant Lymphoma
33
Miscellaneous cause of FUO
Exercise induced hyperthermia
| Drug induced fever
34
Causes of drug induced fever
Allopurinol, carbamazepine, lamotrigine, phenytoin, sulfasalazine, furosemide, anti microbials, nevirapine
35
Exercise induced hyperthermia
Increase body temp associated with moderate-strenous exercise lasting 30mins to several hours not associated with inc in ESR, CRP
36
Most common infectious cause of FUO
Tuberculosis
37
Established imaging procedure in FUO
FDG-PET
38
For FUO pxs with TST positive or with anergy bit with granulomatous disease therapeutic trial with anti TB is indicated for how long
6 weeks
39
Recombinant IL 1 receptor antagonist given to FUO patients
Anakinra
40
Most common mode of entry of microbial pathogens into the alveolar level
Aspiration from oropharynx
41
Roles of alveolar macrophages in hosts defense
Phagocytic (innate)
antigen presenting cell to T cells (acquired)
produce many cytokines and mediators
42
Fever in pneumonia is due to
IL-1 and TNF
43
Peripheral leukocytosis and purulent secretions in pneumonia is due to
IL-8 and G-CSF
44
Capillary leak in pneumonia
Caused by inflammatory mediators released by alveolar macrophages and newly recruited neutrophils
45
Hypoxemia in pneumonia is due to
Alveolar filling
46
Causes of dyspnea in pneumonia
Decreased compliance due to capillary leak, hypoxemia, inc respiratory drive, secretions and interferon related bronchospasm
47
4 stages of lobar pneumonia
1. Edema/congestion
2. Red hepatization
3. Gray hepatization
4. Resolution
48
Predominant cells in gray hepatization
Neutrophils
49
Predominant cells in Resolution stage of Lobar pneumonia
Macrophages
50
Most common pattern in nosocomial pneumonia
Bronchopneumonia
51
Lobar pneumonia pattern is seen in
Bacterial CAP
52
VAP has what type of pneumonia pattern
Respiratory bronchiolitis
53
Typical bacterial pathogens in pneumonia
H. Influenza, s. Pneumonia, s. Aureus, klebsiella pneumonia, pseudomonas aeruginosa
54
Atypical bacterial pathogens in pneumonia
Mycoplasma, chlamydophila, legionella, Resp virus (influenza, adeno, human metapneumo, RSV)
55
Complications of anaerobic pneumonia
Abscess, empyema, effusions
56
Serious consequence of MRSA pneumonia
Necrotizing pneumonia
57
Risk factors for pseudomonas infection
Recent hosp/antibiotic therapy
Structural lung disease (bronchiectasis)
heart/renal failure
Alcoholism
58
Risk factors for Legionella infection
```
Recent hotel stay/cruise ship
Male
Smoking
Renal disease
Immunocompromised (malignancy, HIV)
DM
```
59
Adequate sputum specimen for culture
>25 pmns and <10 squamous cells per LPF
60
Indications for Blood culture for CAP
High risk patients (neutropenia, asplenia, complement deficiency)
chronic liver disease
61
CURB 65
```
Confusion
Urea >7
RR >30
BP <90/60
65 age more than
```
Score
0= Opd
1= ward
2= ICU
62
Sensitivity classification of pneumococcal strains
MIC
= 2 SUSCEPTIBLE
= 2-4 INTERMEDIATE
= 8 RESISTANT
63
Risk factors for penicillin resistant pneumococcal infection
```
Recent antimicrobial therapy
Age <2 or >65
Attendance at daycare centers
Recent hospitalization
HIV infection
```
64
Microbial infection resulting to necrosis and cavitation of the pulmonary parenchyma
Lung abscess
65
Primary lung abscess is due to
Aspiration of anaerobic bacteria or occur in the absence of an underlying pulmonary or systemic condition
66
Classification of lung abscess based on duration
Acute <4-6wks
| Chronic >6wks (40%)
67
Most common location of primary lung abscess
Posterior upper and superior lower
| R>L
68
Most common cause of secondary lung abscess
Pseudomonas, gram negative rods
69
Preferred imaging for lung abscess
CT
70
Treatment for primary lung abscess
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
71
Indication for surgical intervention in lung abscess
Failure of antibiotic tx
| >8cm size
72
Etiologic agents in community acquired native valve endocarditis
```
Oral cavity: viridans strep
Skin: staph
URT: HACEK
GIT: strep bovis/gallolyticus
GUT: Enterococci
```
73
Health care associated NVE
Staph aureus, CoNS, enterococci
74
Prosthetic valve endocarditis
Within 2 mos: s aureus, CoNS, gram neg bacilli, diph, fungi
2-12mos: CoNS
>12mos: community assoc NVE
75
Endocarditis among IV drug users
MRSA affecting tricuspid valve (right sided)
| polymicrobial (left sided)
76
Pathogenesis in IE
Endothelial injury leading to direct infection by virulent organisms and development of platelet-fibrin thrombus (NBTE- non bacterial thrombotic endocarditis)
77
Nonsuppurative peripheral manifestation of subacute endocarditis and related to prolonged infection
Janeway lesions
78
Septic embolization seen in s. Aureus endocarditis
Osler's nodes
79
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
Mycotic aneurysms
80
Diagnosis of IE based on DUKE'S CRITERIA
Definite: 2 major or 1 major 3 minor or 5 minor
Possible: 1 major and 1 minor or 3 minor
81
Hand foot and mouth disease
Coxsackie virus A16
82
Staphylococcal scalded skin syndrome
S. Aureus
83
Gas gangrene
Clostridium
84
Bullous impetigo
Staph aureus
85
Impetigo contagiosa
Strep pyogenes
86
Hot tub folliculitis
Pseudomonas
87
Swimmers itch
Schistosoma
88
Erysipelas
Strep pyogenes
89
Most common causes of infectious arthritis
S. Aureus, neisseria gonorrhea
90
Most common route of entry into the joints
Hematogenous
91
Common joint infection among patients with RA
Polyarticular
92
Periods of greatest risk to develop gonococcal arthritis among women
Menses and pregnancy
93
Culture results of patients with true gonococcal septic arthritis
Synovial fluid and blood
SF: positive in < 40%
Blood: negative
94
Treatment for true gonococcal septic arthritis
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
Reiter's syndrome
```
Urethritis
Conjunctivitis
Uveitis
Oral ulcers
Rash
```
96
Most commonly affected bone with osteomyelitis in adults
Vertebra
97
Acute osteomyelitis is managed with
Antibiotics only
98
Gold standard for diagnosis of osteomyelitis
MRI
99
Most commonly associated with primary (spontaneous) bacterial peritonitis
Liver cirrhosis
100
Most common presentation of patients with primary peritonitis
Fever
101
Diagnostic finding of ascitic fluid of SBP patients
>250/mcL
102
Most common bacterial isolate in SBP
E. Coli or other gram neg
| Typically single organism
102
Most common bacterial isolate in SBP
E. Coli or other gram neg
| Typically single organism
103
Antimicrobial treatment for Primary (spont) bacterial peritonitis
3rd gen ceph (ceftriaxone, cefotaxime)
piptaz
Coverage: gram neg aerobic bacilli, gram positive cocci
104
Bacterial contamination of the peritoneum as a result of spillage from an intraab viscus
Secondary peritonitis
105
Diagnostics for secondary peritonitis
Abdominal tap RARELY indicated, ONLY done in trauma patients
Stable: abdominal CT
Unstable: surgery prior to imaging
106
Antimicrobial treatment for secondary peritonitis
Ticarcillin/clavulanate
Cefoxitin
Levox
Ceftri + metro
ICU pxs: imipenem, merop, ampi+metro+cipro
Coverage: gram neg aerobic bacilli and anaerobes
107
Most common bacteria associated with CAPD peritonitis
Staphylococcus
108
Most common anaerobic isolate in intraabdominal abscess
Bacteroides fragilis
109
Most common cause of intraabdominal abscess
Fecal spillage from a colonic source
110
Highest diagnostic yield for intraabdominal abscesses
Abdominal CT
111
Most common source of liver abscess
Disease of the biliary tract
112
Most common presenting sign of liver abscess
Fever
113
Single most reliable laboratory finding in liver abscess
Increased alkaline phosphatase (70%)
114
Most common pathogens isolated in liver abscess
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
Management for liver abscess
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
More common cause of splenic abscess
Hematogenous
117
Most common infection associated with splenic abscess
Bacterial endocarditis
118
Predisposing risks for splenic abscess
immunosuppressive therapy, hemoglobinopathies, other hematologic disorders( sickle cell)
119
Most sensitive diagnostic tool for splenic abscess
CT scan of the abdomen
120
Most common isolate for splenic abscess
Streptococci
| St aph aureus( 2nd most common)
121
Standard management and best approach to patients with complex, multi localbr, multiple splenic abscess
Splenectomy with antibiotics ( adjunct)
122
Preferred approach to patients with high surgical risk and single<3cm splenic abscess
Percutaneous drainage
123
Portal of entry for perinephric and renal abscess
UTI( 75 %)
124
Most important risk factor for Renal Abscess
Nephronthiasis obstructing urinary flow
125
Most common isolates in Renal Abscess
E .coli, Proteus, klebsiella
126
Most useful diagnostic modalities for Renal Abscess
Renal UTZ and Abdominal CT
127
Treatment for Psoas Abscess
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
Mechanisms of Gastrointestinal Pathogens Cansing diarrhea
Non Inflammatory (enterotoxin)
Inflammatory ( invasion or cytotoxin)
Penetrating
129
Non inflammatory diarrhea usually presents with usterry diarrhea and affects what part of the colon
Proximal Small bowel
130
Enteric fever has what mechanisms of diarrhea affecting the distal colon
Penetrating
131
Cause watery diarrhea by acting directly on secretory mechanisms in the intestinal mucosa
Enterotoxin
132
Causes destruction of mucosal cells and produce dysentery syndrome, with bloody Stools containing Inflammqtory Cells
Cytotoxin
133
Cytotoxin producing enteric pathogens:
Shigella dysenteriae type 1( hemorrhagic colitis)
v. parahaemolYticus
Clostridium difficille
Shigq toxin_ producing strains of E .co li ( HUS)
134
Predominant cause of Nosocomial diarrhea in adults
C. Difficile
135
Considered if with history and stool exam indicating a non inflammatory etiology of diarrhea and there is evidence Of a common - outbreak
Bacterial food Poisoning
136
Associated with contaminated fried rice due to germination of Spore when cooked rice is not refrigerated
Emetic form of Bacillus cereus
137
Diarrhea with slightly longer duration( 8-14 H) results from the survival of heat resistant spores in inadequately cooked meat, poultry or legumes
Clostridium perfringens
138
Culture media For cholera
TCBS agar
139
culture media For Shigella and Salmonella
Mac (onkey agar
140
Inexpensive agent for prophylaxis of travelers diarrhea
Bismuth subsalicylate
141
Resistance of TB bacilli to at least Rifampicin and Isoniazid
MDR- T B
142
Resistance to INH -R- FQ+ One Iv aminoglycoside
XDR-TB
143
most common mode or transmission of TB
Aerosolized droplet
144
Most likely to transmit PTB
(+) Sputum AFB by microscopy
cavitary PTB
laryngeal PTB
145
Non infectiouS TB
culture negative TB and extrapulmonary TB
146
Encodes for catalase/ peroxidase enzyme to protect against Oxidative stress required nor isoniazid activation and subsequent bactericidal activity
k at G
147
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
Isocitrate lyase gene, icl1
148
control of r R NA transcription required for replication and persistence of the host all
car D gene
149
determine susceptibility to TB
NRAMP1(at chromosome 2q)
150
Delayed type hypersensitivity ( DTH) reaction to various bacillary antigens, can destroy un activated macrophages that contain multiplying bacilli and cause caseons necrosis
Tissue damaging response
151
T. cell- mediated phenomenon resulting in activation of macrophages that are capable of killing and digesting tubercle bacilli
macrophage activating response
152
Lymphocytes and activated macrophages evolve to epithelioid and giant cell
Granulomatous lesions ( tubercles)
153
Bacilli remain active forming biofilms in necrotic areas where they temporarily hide
latency
154
Healed lesions in lung parenchyma and hilar Lymph nodes may Later undergo calcification
Ranke complex
155
confers partial immunity against m. tuberculosis
Cell- mediated immunity
156
complication characterized by rupture of dilated vessel in a cavity leading to massive hemoptysis
Rasmussen's aneurysm
157
most common presentation of extrapulmonary TB
TB lymphadenitis
158
Gold standard for Diagnosis OfTB meningitis
CSF culture
159
uncommon manifestation of TB, presents as One or more SOL and usually causes seizure and focal signs
Tuberculoma
160
Most common sites affected by GI TB
terminal ileum and cecum
161
Pathognomonic of military TB
choroidal tubercles( 30 % 0f cases)
162
chronic pulmonary Aspergillosis as a complication of PTB is treated with
Itraconazole 6 months
163
Measure of variability, number AFBin skin scrapings that stain uniformly bright in leprosy patients
morphologic Index
164
A logarithmic scaled measure of the density of M. leprae in the dermis
Bacteriologic Index
| 4+ to 6+ in untreated patients and decreases with effective therapy
165
Relapse or drug resistance in Leprosy patients is indicated by
Increasing Bacteriologic ald morphologic index
166
key component in the cell membrane of M. leprae
Lipoarabinomannan
167
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
Tuberculoid leprosy
168
More severe end Of the Leprosy spectrum
characteristic Leonine facies
Negative Lepromin test
Lepromatons leprosy
169
Most commonly affected nerve trunk in Leprosy
Ulnar nerve
NOTE: median nerve: impairs thumb opposition and grasp
radial nerve: Rare in leprosy leads to wrist drop
170
Partial or complete Footdrop in leprosy
peroneal Nerve palsy
171
Treatment for Leprosy
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
Classification of leprosy based on number of Skin lesions ( WHO)
Paucibacillary < 5 lesions
| multibacillary >/= 5 lesions
173
Classification of leprosy based on number of Skin lesions ( WHO)
Paucibacillary < 5 lesions
| multibacillary >/= 5 lesions
174
Associated with aspirin given to patients with influenza b infection
Reye's syndrome
175
Treatment for refractory arthritis in Chikungunya
Chloroquine
176
Characteristic pathologic CNS finding in rabies
Cytoplasmic inclusions - Negri bodies
177
Two acute neurologic forms of rabies in humans
1. Encephalitic (80%)
| 2. Paralytic (20%)
178
Six genus of plasmodium causing malarial infections in humans
```
P. Malaria
P. Falciparum
P. Vivax
P. Ovale (2 morphologically identical sympatric species)
P. Knowlesi
```
179
Pathogenesis of malaria
Due to direct effects of rbc invasion and destruction by the asexual parasite and the hosts reaction
180
In patient infected with malaria when do symptoms occur
When merozoites are released into the bloodstream reaching densities of 50/ul of blood (100M parasites in the blood of an adult)
181
Responsible for relapses in p. Vivax and ovale
Hypnozoites
Remains dormant in the liver for 3 weeks to a year
182
When merozoites invade rbcs the become
Trophozoites multiplying 6-20 fold every 48-72H
183
At the end of the intraerythrocytic stage the trophozoite nearly consumes 2/3 of the rbcs hgb and has grown to occupy thw cell
Schizont
184
Schizogony/merogony
Mult nuclear divisions, rbc ruptures to release 6-30 daughter merozoites capable of invading new rbcs to repeat the cycle
185
Transmission of malaria
Parasites develop morphologically distinct, longer lived SEXUAL forms (gametocytes) that can transmit malaria
186
Sporogony in malaria
When a biting female anopheline mosquito ingests a gametocyte and forms a zygote in its midgut which will later mature and produce sporozoites
187
Most common measure of malaria transmission rate
Entomologic inoculation rate
188
Fever spike patterns in malaria
Tertian every 2 days
| Quartan every 3 days
189
Genetic disorder that confers protection against death from falciparum malaria
```
Sickle cell disease
Hemoglobin C and E
Hereditary ovalocytosis
Thalassemia
G6PD
```
