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Step 2 Rotation Cards > Inf Dz > Flashcards

Inf Dz Flashcards

1
Q

abx ladder for gram (+) coverage

A

PCNs –> naficillin –> Vanco –> Linezolid

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2
Q

abx ladder for gram (-) coverage

A

PCNs –> ampicillin/amoxicillin ( + beta lactamase - gives some gram (+) coverage) –> pipicercillin ( + tazobactam gives some gram (+) coverage) –> carbapenams

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3
Q

generations of cephalosporins

A

1st gen - gram + coverage
2nd gen - gram + coverage
3rd gen - gram (-) coverage
4th gen - gram (-) coverage and some gram (+) coverage

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4
Q

fluoroquinolones

A

1st - cipro
2nd - levofloxacin
3rd - moxifloxacin

each generation contains prior generation benefits

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5
Q

anaerobic coverage

A

metro - groin and abdomen

clindamycin - everywhere else

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6
Q

abx coverage of CAP

A 
ceftriaxone + azithromycin (IV) 
or
moxifloxacin (oral or IV) 
or
azithromycin (oral)
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7
Q

abx coverage of health care association pna

A

vancomycin
+
pip/tazo

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8
Q

abx coverage of meningitis

A 
ceftriaxone 
\+ 
vancomycin 
\+/- 
steroids (M3 level everyone)
\+/- ampicillin (if immunocompromised)
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9
Q

abx coverage of UTI

A 
amoxicillin (pregnant) 
or 
nitrofuranotin (female) 
or 
TMP-SMX 
or 
Ceftriaxone (inpatient pyelo tx) 
or 
Cipro (ambulatory pyelo)
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10
Q

basic tx of HIV

A

antiretrovirals 2+ 1
2 - NRTs - emtricitabine + tenofovir
+
1 - either NNRT, PI + ritonavir, entry inhibitors, fusion inhibitors

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11
Q

pre exposure prophylaxis

A

2 NRTs

- emtricitabine + tenofovir

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12
Q

post exposure prophylaxis

A

2 NRTs + 1

- emtricitabine + tenofovir (+/-) raltegravir (PI)

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13
Q

pregnancy

A

AZT

to prevent vertical transmission

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14
Q

risk factors of HIV

A

sex (0.2%)
IV drug use and needle sticks (0.3%)
vertical transmission (25%)

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15
Q

antiretroviral syndrome

A

acute HIV infection
“flu like symptoms”

dx - PCR (elisa is too soon here)

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16
Q

dx of HIV

A

ELISA –> confirmatory test = western blot –> tell pt now —–> run viral load + CD4 + genotype (shows sensitivity to meds)

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17
Q

CD4 counts bugs emperic abx

A

CD4 count bugs abx
<200 PCP TMP-SMX or dapsone or atovaquone
(if G6PD)
<100 . toxo TMP-SMX - propymethramine + leucovorin

<50 MAC . weekly azithromycin

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18
Q

primary TB infection

A

lobar pneumonia that just doesn’t get better

cavitations - casseating granulomas

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19
Q

secondary TB infection (reactivation)

A

ghon complex
apical lesions - low O2 tension
hemopytsis, night sweats, weight loss

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20
Q

asymptomatic screening

A

TB test –> PPD or quantiferon assay –> + –> CXR –> + AFB smear –> + –> activation TB –> RIPE

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21
Q

PPD readings that are positive

A

> 5mm - if immunocompromised
10mm - if health care worker, travel to endemic areas, prison, homeless
15mm - soccer mom

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22
Q

TB tx for latent infection and active infection

A

latent TB - INH + B6

active TB - RIPE
R - rifampin - ADR - red body fluids
I - INH - ADR - peripheral neuropathy give B6
P - Pyrazinamide - ADR - hyperuricemia, gout
E - ethambutol - ADR - red green colorblindness

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23
Q

pt with history of BCG vaccine

PPD or interferon gamma assay

A

interferon gamma assay

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24
Q

+PPD and (-) CXR –>

A

INH + B6

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25
Q

most sensitive and specific TB test =

A

NAAT
PCR

adenosine deaminase for bodily fluid testing

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26
Q

SIRS (systemic inflammatory response syndrome) criteria

A

Temp >38 or <36
WBC > 12 or < 4
HR > 90
RR > 20

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27
Q

Sepsis severity

A

SIRS - if 2/4 (+)
Septic - if SIRS + and source present

Severe sepsis >1 organ dysfunction - that responds to fluid
(vs)
Septic Shock >1 organ dysfunction - that does not respond to fluid - needs pressors

MOD - multi organ dysfunction >2 organ dysfunction

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28
Q

Goals of tx of sepsis

A

central venous pressure 10-12
urine output > 0.5cc/kg/hr
MAP >65
Centreal venous oxygen sat > 70%

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29
Q

therapy for sepsis

A

abx
fluids 2-3L
remove source - foley, central line, ET tube, abscess, etc

vasopressors if needed

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30
Q

organs affected by sepsis

A 
heart - hypotension 
brain - AMS
kidney - increased BUN/Cr
Liver - increased LFTs
Lungs - ARDS
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31
Q

safe to do an LP or not

A 
if any + cant do LP --> do CT if (-) --> LP
F - FND 
A- AMS
I- immunocompromised 
L - local lesion impeding LP 
S- seizures
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32
Q

not typical bacterial causes of Meningitis

A 
Crypto 
Rocky Mountain Spotted Fever 
Lyme Disease 
TB 
Syphillis
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33
Q

crypto meningitis

A

AIDs pt with fever and HA
>20cm opening pressure
crypto antigen&raquo_space;> india ink

tx - amphotercin

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34
Q

Rocky Mountain spotted fever meningitis

A

fever
rash from arms to trunks
tick bites
camping

ab on CSF

tx - ceftriaxone

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35
Q

lyme dz meningitis

A

connecticut
targetoid rash with arhralgias
arrhythmias
lyme ab

tx - ceftriaxone

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36
Q

TB meningitis

A

night sweats weight loss hemoptysis
homeless prison
endemic area

tx - RIPE

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37
Q

Mass lesion found on non con CT head –>

A

HIV/AIDs -> yes -> Toxo ab -> yes -> toxo tx -> rescan in 6wks to see if lesion gone
(if lesion still there go to biopsy

if no to toxo ab or HIV/AIDs –> brain biopsy

  • brain abscess -> drain/abx
  • cancer -> chemo/radiation
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38
Q

LP showing predominantly lymphocytes –> encephalitis ->

HSV - temporal lobs and hemorrhagic LP

A

HSV PCR –> + –> tx HCV –> acyclovir

HSV PCR –> (-) –> other causes - st louis, quine, west nile etc –> supportive tx

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39
Q

LP needed but meets FAILS criteria next step

A

give emperic abx –> CT scan –> if no lesion seen –> LP good to go

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40
Q

cellulitis path

A

staph aureus (likes to form abscesses)

strep group A (no abscesses)

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41
Q

presentation of cellulitis

A 
red 
hot 
tender 
well demarcated 
site of entry
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42
Q

dx of cellulitis - clinical

tx of cellulitis -

A

non toxic

  • staph - oral TMP-SMX or clinda
  • strep - 1st gen cephalosporin

Toxic

  • staph - vanc, linezolid, or clinda (IV)
  • strep - Pip/Tazo and ampicilli/ calvulanate
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43
Q

tx of cellulitis if diabetic

A

vanc and pip/tazo

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44
Q

path of osteomyeltis

A

infection of bone

hematogenous or direct innoculation via a penetrating injury

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45
Q

pt presentation of osteomyelitis

A

wound - probe bone
sinus draining tracts
recurrent or refractory cellulitis

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46
Q

dx of osteomyelitis

A

1st x-ray (+after 2wks) –> if (-) –> MRI (best test)

bone scan okay if no cellulitis present
biopsy is great gets specific bug

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47
Q

tx of osteomyelitis

A

debridment
4-6wk (vanc and pip/tazo)

follow up with ESR and CRP

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48
Q

Gas gangrene path

A

clostridium perfinges

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49
Q

gas gangrene presentation

A

penetrating wound that got contaminated

crepitus present

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50
Q

dx of gas gangrene

A

x-ray shows you gas

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51
Q

tx of gas gangrene

A

debridment

PCN and clindamycin (ribosome 50s - blocks toxin production)

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52
Q

necrotizing fascitis path

A

staph and strep

if in groin called fournier gangrene

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53
Q

presentation of nec fasc

A

cellulitis and ……

  • toxic person
  • pain out of proportion to the physical exam
  • blue/gray discoloration
  • rapidly spreading
  • crepitus
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54
Q

dx of nec fas

A

x-ray shows gas –> immediate debridment which includes biopsy

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55
Q

tx of nec fas

A

immediate debridment –> get biopsy

3rd gen cephalosporin + clinda + ampicillin

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56
Q

MCC of osteomyletis

A

staph auerus

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57
Q

Sickle cell pt and staph not on option

A

salmonella

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58
Q

penetrating wound and sneaker involved in osteomyeltis

cause

A

pseudomonas

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59
Q

diabetic with osteomyeltits

A

pseudomonas

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60
Q

oyster consumption in cirrhotic

A

vibrio vulnificus

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61
Q

gardening osteomyeltis

A

sporotrichix

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62
Q

CAP vs HCAP (HAP)

A

-CAP
>90 days from med building
<48 hrs admission

-HCAP
<90 days from med building
>48hrs admission

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63
Q

CAP Bugs

A

Strep Pna - MCC
Moraxella Catarhalis
H Influenza - COPD
Klebsiella (aspiration/etoh/AMS)

Staph Auerus (postviral) 
Legionella (immunosuppressed, smoker)
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64
Q

tx of CAP

A 
3rd gen cephalosporin 
\+ 
Macrolide 
or 
Moxifloxacin
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65
Q

HAP = HCAP bugs

A

pseudomonas

MRSA

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66
Q

HCAP tx

A

pip/tazo

vancomycin

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67
Q

immunosuppressed and PNA bugs

A

TB
Fungal
PCP

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68
Q

influenza PNA

A

fever cough myalgias
dx - nasopharyngeal swab or BAL

tx - oseltamavir - prevent with vaccine

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69
Q

ED

PNA - admit or nah?

A 
CURB-65 
C - confusion
U - bUn >19
R - rr >30 
B - blood pressure - sys <90, dias <60
65 - >65 y/o
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70
Q

Fever and cough work up

A

CXR

  • > (-) –> bronchitis –> oral abx
  • > cavitary lesion -> CT scan -> fungus/TB/abscess
  • > (+) consolidation -> PNA -> building and time?
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71
Q

bronchitis tx

A 
oral abx 
macrolide (azithromycin) 
or 
doxycyline
or 
moxifloxacin
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72
Q

lung absces tx

A

DONT DRAIN

3rd gen cephalosporin
+
clindamycin

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73
Q

PNA in an HIV/AIDs

A

patchy bibasilar infiltrates
CD4 <200

dx - sputum silver stain

tx - TMP-SMX
—-> if hypoxemic or low PaO2 give steroids

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74
Q

abx duration for uti to pyelo

A

uncomplicated cystitis - 3days
complicated cystitis - 7days
pyelonephritis - 10days
perinephric abscess -14days

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75
Q

bugs in urinary infections

A

E coli 80%
klebsiella
proteus

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76
Q

risk factors for UTIs

A

18-25 year old females on contraception having sex
females = shorter urethrea
men -anal sex

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77
Q

diagnosing UTIs

A

UA: (+) if leukocyte esterase, nitrites, >10 wbcs/hpf

urine culture: if pt preg, urological procedure, 10^5 CFU, abx sensitivities

CT scan - non preg pts
US - preg pts

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78
Q

complicated cystitis

uncomplicated = non preg female

A 
P's 
penis - male 
plastic - catheters, foleys
procedures - urological 
Pyelo
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79
Q

urethritis

A

STD - gonorrhea, chlamydia
discharge

dx - swab/urine test

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80
Q

tx of urethritis

A 
ceftriaxone 250mg x1 IM 
\+ 
azithromycin po x1
or 
doxycycline po daily  x7days

f/u - hiv screen

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81
Q

asymptomatic bacteruria screen

A

preg female or urologic procedures
path - gram neg rods and group B strep

tx - preg - amoxcillin (if PCN allergy nitrofurantoin)

repeat screen in f/u

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82
Q

cystitis

A

path - gram - rods
urgency, frequency, dysuria, young female

dx - U/A

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83
Q

tx of cystitis

A

empiric - TMP-SMX (unless CKD) or nitrofurantoin or fosfomycin

complicated 7 days
uncomplicated 3 days

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84
Q

pyelonephritis

A

path - gnr
urgency frequency dysuria fever chills CVAT

dx - U/A - wbc casts -> urine culture

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85
Q

tx of pyelonephritis

A

IV - ceftriaxone - hospitalized -> see if abscess is present -> if no improvement in <72hrs –> CT scan or US (if preg)

IV cipro –> Po cipro (ambulatory pyelo)

10days in duration

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86
Q

tx of nephritic abscess

A

14 days of IV ceftriaxone

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87
Q

ulcer work up –>

A

of ulcers
is there pain?
lymphadenopathy present?

88
Q

types of genital ulcers

A

syphillis
lymphogranulomvenerum
chancroid
herpes

89
Q

Syphillis

path and pt presentation

A

path - trep pallidum

1 - painless singular ulcer and non tender LAD

2 - fever and rash, targetoid rash - palms and soles

3 - neurosyphillis, tabes dorsalis (DCLMS), argyll roberston pupil

90
Q

Dx of Syphillis

A

1 - darkfield microscopy
2- RPR + –> FTA -abs trep
3 - LP –> RPR on CSF –> FTA-ABs on CSF

91
Q

Tx of Syphillis

A

1 - PCN x1 IM
2 - PCN x1 IM
Early latent (exposure <1yr) - PCN x1 IM

3 - PCN IV Q4 hr 10-14 days 
Late latent (exposure >1yr) - PCN IM weekly x3 weeks
92
Q

Lymphogranulomvenerum

A

path - C Trachamotasis

painless singular ulcer
(+) tender Lymph Nodes - suppurative and draining

dx - NAAT

tx - doxycycline

93
Q

Chancroid

A

path - Haemophils Ducreyi

Painful single ulcer with tender Lymph Nodes

dx - gram stain and culture

tx - azithromycin or cipro

94
Q

Herpes

A

path - HSV1 or HSV2

painful burning prodrome
painful ulcers - vesicles on erythematous base, (coalesce into an ulcer shape)

dx - PCR

tx- Acyclovir or Valacyclovir

95
Q

RPR measurements

A

1:3
1:3000
the bigger the 2nd number the worse the dz

96
Q

otitis media path

A

URI bugs - strep pna, moraxella catarhalis, H influenza

middle ear - TM

97
Q

otitis media presentation

A

Unilateral Ear Pain - relieved by puling on pinna
bulging erythematous TM
loss of light reflux
fluid behind ear

98
Q

Otitis Media Dx

A

pneumatic insuflation - TM rigid = (+)

99
Q

tx of Otitis Media

A

1st line - amoxicillin
recur - amox + clavulanate
recur 3/6 or 4/12 –> tymphanoplasty

PCN allergy - non life threatening - Cefidinir
PCN allergy - life threatening - Azithromycin

100
Q

Otitis Externa

A

path - outer ear - pinna canal
Swimmers ear - Pseudomonas
Digital trauma - Staph Aureus

101
Q

Otitis Externa presentation

A

unilateral ear pain - made worse puling pinna

outer canal is erythematous - no bulging TM

102
Q

dx and tx of Otitis externa

A

dx - clinical
tx - spontaneously resolves
if toxic —-> abx - Cipro drops + steroids

103
Q

Complication of otitis exertna

A

Mastoiditis

104
Q

Mastoiditis

A

path - URI bugs - ppl with ear tubes

loos like AOM + swelling behind ear, anterior rotation of ear

dx - clinical
tx - surgical decompression

105
Q

Sinusitis path and presentation

A

path - URI Bugs - strep pna

congestion
bilateral purulent discharge - thick and white smelly
facial tap = painful

106
Q

Sinusitis

dx and tx

A

airfluid levels -xray opacification - CT

dx - clinical
tx - supportive unless:

–> temp >38
–> >10days
–> worsening
(if any (+) —-> PCN - amox + clavulanate)

107
Q

recurrent sinusitis –>

A

CT scan to see if anatomical abnormality

108
Q

Cold “nasal viral”

A

path - rhinovirus, air droplets

congestion, bilateral clear discharge, rhinorrhea-copius

tx - supportive

109
Q

Pharyngitis

A

path - viral, group A strep

sore throat, odynophagia 
C - no cough 
E - exudates
N - nodes 
T - temp >38
OR: <14 = +1
>44 = (-1)
110
Q

pharyngitis tx

A

amoxicillin + clavulanate

111
Q

major criteria in IE

A

bacteremia
new regurgitation murmur
Echo - vegetation

112
Q

Minor criteria in IE

A

Risk Factors - IV drug abuse, prosethetic valves, hx of endocarditis

Fever - >38

Vascular - septic emboli, embolic CVA, Acute Limb ischemia, Splinter hemorrhage - nail beds, janeway lesions painless

rheumatological - roth spots, osler nodes (painful) glomerulonephritis

113
Q

Acute IE

aggressive

A

path - staph auerus and strep pneumoniae

CHF presentation, bacteremia, toxic, no time = (-) rheum symptoms

Give empiric abx until blood cultures are (-)

114
Q

Subacute IE

indolent

A

path - HACEK

fever on and off, nontoxic, (+) rheum symptoms enough time

blood cultures then if (+) –> empiric abx

115
Q

tx of acute IE

A

native valve –> Vancomycin

prosthetic valve <60 –> vanc +gent + cefepime
prosthetic valve 60-365 –> vanc + gent
Prosthetic valve >365 –> vanc +gent + ceftriaxone

116
Q

tx of subacute IE

A

gent + ceftriaxone

117
Q

Surgical indications for IE

A

CHF
vegetations >15mm
Vegetations >10mm and embolization
abscess/fungus - abx wont work

118
Q

prophylaxis tx for IE

A

when bad valve or dental oral procedure

amoxicillin = tx choice

119
Q

dx test of choice of IE

A

TEE

120
Q

multilobular consolidation indicates

A

severe pneumonia

121
Q

a normal pulse in the setting of a high fever is suggestive

A

of atypical CP pneumonia

pulse-temp dissociation

122
Q

what PNA bug associated with nursing home residents

A

pseudomonas

123
Q

Ventilatory associated PNA RF

A

increased risk due to not being able to cough
decreased mucociliary clearance

dx - new infiltrate on CXR - purulent secretions from ET tube, fever and increasing WBC

124
Q

tx of ventilator associated pna

A 
cephalosporin (ceftazidine or Cefepime) 
\+ 
aminoglycoside 
\+ 
vancomycin or Linezolid
125
Q

lung abscess pearls

A

posterior segments of upper lobes
superior segments of lower lobes
right lobe

126
Q

lung abscess CXR

A

air fluid levels

thick walled cavitations

127
Q

TB transmission

A

aerosolized droplets from someone with ACTIVE TB

128
Q

secondary TB reactivation

A 
common in immunocompromised hosts 
HIV 
Malignancy 
Immunosuppressants 
substance abuse 
poor nutrition
129
Q

risk factors for TB

A 
HIV + 
prisoners 
health care workers 
diabetes 
close contact 
alcoholics 
glucocorticoid use 
IV drug use 
hematologic malignancy
130
Q

symptoms of primary secondary TB

A

primary - asymptomatic - ghon complex

secondary - fever night sweats, weight loss, malaise

131
Q

ghon complex

A

calcified primary focus with an associated lymph node

ranke complex = ghon complex that undergoes fibrosis and calcification

132
Q

tx of TB

A

RIPE for 2 months –> INH and Rifampin for 4 months

133
Q

influenza

epidemics vs pandemics

A

epidemics - common - due to minor genetic reassortment

pandemics - rare - due to major genetic recombination

134
Q

TB meds and hepatotoxicity

A

all meds cause it

dont discontinue unless 3 to 5x upper limits of nml

135
Q

complications of meningitis

A

seizures
coma
brain abscesses
subdural empyema

deafness, brain damage, hydrocephalus

136
Q

CSF profile of bacterial meningitis

A

increased WBC - PMNs predominate
Low glucose
High protein

137
Q

viral causes of Meningitis

A

herpes (HSV-1)
arbovirus - eastern equine encephalitis, west nile virus
Enterovirus - polio

138
Q

non viral infectious causes of meningitis

A

toxoplasmosis

cerebral aspergillosis

139
Q

non infectious causes of meningitis

A

metabolic encephalopathies

T cell lymphoma

140
Q

risk factors for encephalitis

A 
AIDs - CD4 <200 - think toxo 
Immunosuppression 
Travel to underdeveloped countries 
mosquitos (endemic areas) 
Bats
141
Q

nonbacterial causes of brain abscesses

A

toxo and fungi in aids pts

candida spp, aspergillosis, zingomycosis (neutropenic pts)

142
Q

Hep B associations

Hep C associations

A

Hep B - PAN

Hep C - Cryptoglobulinemia

143
Q

transmission of Hepatitis

A

Hep A and E - fecal oral
Hep B - drugs and sex
Hep C - drugs

144
Q

causes of transaminases >500

A

acute hepatitis - viral
shock liver
drug induced hepatitis

145
Q

fulminant hepatitis

A

severe complication of hepatitis

liver failure - life threatening

146
Q

other complications of hepatitis

A

hepatic encephalopathy - asterexis and palmar erythema

hepatorenal syndrome - venous thrombosis

bleeding diathesis - only when liver function is severe

147
Q

Tx of hepaititis
Hep B
Hep C

A

hep B - IFN alpha or Lamivudine

Hep C - IFN alpha and ribavirin

148
Q

most frequent indication for liver transplant in the US

A

HCV

149
Q

presentation of botulinism

A

symmetric descending flaccid paralysis –> starting with dry mouth, diplopia, and/or dysarthria, –> paralysis of limb musculature

150
Q

causes of intrabdominal abscesses

A 
spontaneous bacterial peritonintis 
pelvic infections tuboovarian abscesses 
pancreatitis* 
gi tract perf * 
osteomyelitis of vertebral bodies
151
Q

non infectious causes of cystitis

A

cytotoxic agents - cyclophosamide
radiation to pelvis
dysfunctional voiding
interstitial cystitis

152
Q

when to obtain a urine culture

A

> 65 y/o
DM
recurrent UTIs

> 7 days with symptoms
use of diaphragm as contraception device

153
Q

when do you tx asymptomatic bacteruria

A

pregnant

before having a urological procedure

154
Q

risk factors for upper UTI

A

pregnancy
diabetes
VUR

155
Q

tx of dysuria specifically

A

pyridium (phenazopyrdime) - urinary analgesic - 1-3 days

156
Q

acute prostatis

A

fever
tender prostate
boggy prostate

younger men
due to ascending infection from urethra

157
Q

chronic prostatis

A

well appearing
nml prostate just large
recurrent UTIs

158
Q

chlamydia is a risk factor for

A

cervical cancer

159
Q

leading cause of infertility in women

A

due to chlamydia infections that lead to tubal scarring

160
Q

C-section in HIV women

A

indicated if viral load >1,000

161
Q

if viral load is >50 after 4 months of tx for HIV

A

change regiment

162
Q

gold standard for dx of HSV

A

culture

tzanck smear = quickest

163
Q

Chancroid

A

haemophilus ducreyi
painful raw ragged borders beefy red

tx - azithro

164
Q

causes of false (+) RPR or VDRL

A

SLE
antiphospholipid syndrome
Lyme dz

165
Q

lymphogranuloma venereum

A

C trachomatis
painless ulcer
tender inguinal lymphadenopahty (Unilateral)

tx - doxy

166
Q

causes of cellulitis with exposure to water

A

pseudomonas

vibrio vulnificus

167
Q

Predisposing factors to erysipelas

A 
lympahtic obstruction 
radical mastectomy 
local trauma 
abscess, fungal infections 
DM 
alcoholism
168
Q

risk factors for necrotizing fascitis

A

surgery
diabetes
trauma
IV drug use

169
Q

bugs that cause of necrotizing fascitis

A

strep pyogenes

clostridium perferenges

170
Q

pathophys of tetanus

A

causes by neurotoxins produced by spores

exotoxin blocks inhibitory transmitters at the NMJ

171
Q

tetanus managment

A

give diazepam for tetani

IM tetanus IG (TIG)

172
Q

tetanus wound management

A

< 3doses of Td or >10yrs

  • clean - Td
  • dirty - Td + TIG

> 2 doses of Td

  • clean - nothing
  • dirty - nothing
173
Q

bugs for osteomyletis

  • catheter
  • prosthetic joint
  • diabetic foot ulcer
  • nosocomial infections
  • IV drug use or neutropenia
  • Sickle cell -
A
  • catheter - staph
  • prosthetic joint - coagulase neg staph
  • diabetic foot ulcer - polymicrobial
  • nosocomial infections - pseudomonas
  • IV drug use or neutropenia - fungal
  • Sickle cell - salmonella
174
Q

pott disease

A

osteomyeltis of the vertebral bodies due to M tuberculosis

175
Q

clinical findings of osteomyelitis

A

pain over the involved area of bone

localized erythema or swelling
some systemic symptoms
draining sinus tract - chronic issue

176
Q

for osteomyelitis how do monitor response to tx

A

ESR and CRP

177
Q

dx test of choice for osteomyelitis

A

MRI

178
Q

Gonococcal arthritis

A

presents with acute monoarthritis
progresses within days in a migratory or additive pattern

tenosynovitis is present in the hands and feets

179
Q

complications of septic arthritis

A

destruction of joint and surrounding structures (ligaments, tendons) –> stiffness and pain and LOF

avascular necrosis (hip) 
sepsis
180
Q

Clinical features of rocky mountain spotted fever

A

sudden onset of fever, chills, malaise, N/V

rash - appears after 4-5 days of fever

  • starts on peripherally –> centrally
  • papular –> maculopapular –> petechial

tx - doxy

181
Q

fever patterns of malaria

A

falciparum - constant - worst one

ovale and vivax - q48hrs

malariae - q72hrs

182
Q

tx of malaria

A

chloroquine if not resistant

if resistant - quinine sulfate + tetracyclines

183
Q

prophylaxis for malaria

A

mefloquine if chloroquine resistance

184
Q

ADR of malaria meds

atovaquone
mefloquine
chloroquine - benefit
primaquine

A

atovaquine - C/I - preg and renal dz

mefloquine - C/I - sz and psych

chloroquine - good in preg

primaquine - C/I - G6PD def —> HA

185
Q

Leptosporosis

A

contaminated water
reservoir - rodents, farm animals

rash, LAD, increased LFTs
renal and/or liver failure
vasculitis, vascular collapse

tx - oral abx - tetracycline or doxycycline if severe IV PCN G

186
Q

Q Fever

A

farm animals
acute - constitutional symptoms N/V
chronic - endocarditis

CXR - multiple opacities in acute illness

tx - acute - doxy and chronic - rifampin

187
Q

Cat scratch disease

A

bartonella henselae
serology
LAN or lymphadenitis

Tx - self limiting,
severe doxy or cipro

188
Q

cutaneous candidiasis

A

erythematous eroded patches with satellite lesions

more common in obese diabetics pts
appears in skin folds, underneath breasts and in macerated skin

189
Q

allergic bronchopulmonary aspergillosis

A

type I HSR
asthma and eosinophilia
avoid exposure and corticosteroids

190
Q

pulmonary asperigiloma

A

inhalation of spores into the lungs
RF - hx of sarcoidosis, histo, TB and bronchiectasis

tx - pts with massive hemopytsis may need lobectomy

191
Q

invasive aspergillosis

A

immunocompromised pts
(+) fever, resp distress, despite use of broad spectrum abx

hyphae invade lung vasculature -> thrombosis and infarct
bilateral pulm infiltrates

192
Q

tx of invasive aspergillosis

A

IV amphotercin B

193
Q

cryptococcosis neoformans
dx
tx

A

dx - latex agglutination, india ink smear - encapsulated yeasts, biopsy - lack of inflammatory response

tx - amphotercin B + flucytosine –> fluconazole

194
Q

causes of hyperthermia

A

neuroleptic malignant syndrome
malignant hyperthermia
heat stroke

195
Q

hyperthemia
responds to
doesnt respond to

A

doesnt respond to antipyertics

does respond to external cooling measures

196
Q

Toxic shock syndrome risk factors

A

menstruating women with tampons

surgical wounds, burns and infected insect bites

197
Q

toxic shock syndrome caused by

A

enterotoxin of staph aureus or group A strep (rare)

198
Q

clinical features of TSS

A

abrupt
flu like
diffuse macular erthematous rash - desquamates over palms and soles

strawberry tongue
hypotension

199
Q

tx of TSS

A

hemodynamic stabilization –> remove source, drain and debride wounds –> give anti staph abx (naficillin, oxacillin, vanc)

200
Q

MCC of catheter related sepsis

A

central lines

increased risk with emergent placement, femoral lines, indwelling of the line

201
Q

bugs of catheter related sepsis

A

staph aureus

staph epidermidis

202
Q

neutropenia def

A

ANC < 1,500

ANC <500 –> severe infection risk

203
Q

causes of MONO

A

EBV mainly (CMV - rare)

204
Q

CMV mono

A

sexually active young adults
(-) cervical adenopathy
(-) pharyngitis
(-) heterophile abs

205
Q

complications of mono

A

bells palsy

206
Q

blastomycosis basics

dimorphic fungi

A

inhaltion of spores
chronic indolent - constitutional symptoms, LAN, PNA

tx - itraconazole

207
Q

histo basics

dimorhphic fungus with septate hyphae

A

exposure to bird/bat shit
ohio and mississippi valleys

flu like, erythema nodosum, hepatosplenomegaly

tx - itraconazole

208
Q

coccidiomycosis

dimorhic fungi

A

inhalation of spores
asymptomatic
dissemination -> CNS issues

tx - fluconazole

209
Q

sporotrichosis

dimorhphic - cigar shaped yeast

A

invasion of skin via thorn - gardening
lymphocutaneous form - hard sub q nodules - > ulcerate and drain

disseminated .-> pna and meningitis

tx - potassium iodide x itraconazole

210
Q

cryptosporidiosis

spore forming protozoa

A

fecal oral
watery diarrhea - immunocompromised
oocytes

tx - supportive

211
Q

amebiasis

A

entamoeba histolytica
fecal oral, contaminated water/food/ anal oral sex

bloody diarrhea, tenesmus, abd pain +/- liver abscess
trophozoites

tx - metro for liver

212
Q

giardiasis

A

fecal oral, daycare camping
watery diarrhea, chronic infection, weight loss

trophozoites or cysts

tx - metro

213
Q

ascariasis

round worm

A

ingestion of food or water contaminated by human feces

postprandial abd pain, vomiting, heavy worm burden
pancreatic duct, common bile duct obstruction

eggs or adult worms

tx - albendazole, mebendazole, or pyrantel pamoate

214
Q

hookworm

necator americanus

A

larvae invade skin - travel to lung - cough and swallow -> intestine

cough, anemia, malabsorption, weight loss, eosinophilia

adult worms

tx - mebendazole or pyrantel pamoate

215
Q 
tapeworm 
taenia saginata (beef)
taenia solium (pork)
diphyllobothrium latum (fish)
A

eating raw or undercooked meat

usually asymptomatic, abd pain, weight loss
fish tapeworm: vit b12 def

tx - praziquantel vit b12

216
Q

Schistosomiasis (trematodes)
schistosoma haematobium
schistosoma japonicum

A

penetrating human skin —> migrate to lungs -> portal vein –> venules of mesentery, bladder or ureters

S mansoni and S japonicum: fever, diarrhea, -> liver fibrosis, portal HTN

tx - praziuantel

Step 2 Rotation Cards (14 decks)

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