infection Flashcards

1
Q

catheter removal indication in catheter-related blood stream infection

A

severe sepsis
hemodynamic instability
evidance of metastatic infection
pus at the exit site f the catheter
continued symptoms after 72 hours of empiric therapy
long term more than 14 days ; if the blood culture is s aureus , Pseudomonas or fungai

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2
Q

Lyme disease

A

erythema migrans < fatigue headache and myalgia and arthralgia,

erly disseminated; erythema migrans, unilateral or bilateral cranial nerve palsy( like & (looks like bells palsy)
meningitis, carditis migratory arthralgia,
late; arthritis encephalitis and peripheral neuropathy

arthritis ( 20,000 neut ( vs bacterial def more than 50,ooo)

28 days of doxycycline and you are disease free

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3
Q

cryptococal meningitis treatment

A

induction : amphotericin B and flucytosin for two weeks antiviral after this phase)
consolidation ; high dose oral fluconazole for 8 weeks;
maintenance ; low dose fluconazole for more than a year

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4
Q

therapy for necroziting fasciatis

A

Ab start surgery
piperacilin azobactam or imipenem + vanco+clinda (for toxins)

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5
Q

ART treatment and viral load

A

4 weeks less than 5000
8-12 weeks less than 500
16-24 less than 50

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6
Q

low and high clostrdiodes difficile infection AB

A

high; fluoroquinolones , clinda, 3-4 cephal, carbapenem, monobactam

low : cotri, macrolides tetra amino

we can change the AB and extend it till the end of other AB therapy

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7
Q

lyme and pregnancy

A

no congenital is reported , amoxicilin is the drug of choice and for 14-21 days

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8
Q

cat scratch disease treatment

A

azthro

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9
Q

corticosteroid use in pneumonia (PCP ) patients

A

A-a gradiant lmore than 35 or Pa O2 less than 70

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10
Q

breast feeding and doxy

A

no

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11
Q

aspergilosis biomarkers

A

galactomannan, beta d glucan
noduled in imaging ( IMP) with ground glass opacities ( halo sign)
voriconazole for treatment

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12
Q

Hi management in pregnancy

A

viral load montly til undetectable then 3 months
CD4 every 3 mnthes
avoidance of aminocentesis if detectable viral load
avoidance of artificial ROM, scalp electrode, operative vaginal delivery
under 50 art+ vaginal
till 1000 art +zido + vaginal
more than 1000. art + zido+ cesarean

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13
Q

breast feeding contra

A

active untreated TB
HIV
herpetic breast lesions
active VZV
chemo or radiotherapy
active substance use

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14
Q

meningococcal meningitis AB prophylaxis

A

who live in the same house or more than 8 hours within 3 feet, secretions( intubation),
child care workers

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15
Q

ecythema gangrenosum

A

pseudomona , painless red macules rapifly progressive to bullae and then gangrenous ulcers

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16
Q

no treatment for heb b unless

A

INR more than 1.5 or multiple comorbities(hepc and HIV) prolonged ( more than 4 weeks)

17
Q

latent tb treatment

A

isoniazid 609 months
rifampine 4 months or
riphampine +izoniazide 3 months

18
Q

cystic fibrosis

A

CFTR gene
AR
recurrent sinopulmonary inf
intestinal obstructions
pancreatic insufficiency and diabetes
male infertility
elevated sweat chloride
abnormal nasal potential difference
nutritional support
airway clearance
AB(staph and pseudo)

19
Q

VZV IG and Vaccine

A

if vaccine 2 dose then ok
if not if immunosuppressive we give variIVIG but if not only vaccines

20
Q

left apical ventricular aneurysm

21
Q

drug resistance fosfomycine vancomycin and penicilin and cephalosphorins

A

fosfomycin; nam nag that inhibits mura : efflux pump or alterations to mura that prevent binding
vanco; d alanin : d lactate
pen and cephal; production of penicilinase ( beta lactam binding )
tetra : eflux or altrations to the ribosome ( binding site)

22
Q

vaccines for HIV infections

A

HAV,HBV,HPV,influanza<(inactivated),meningococcal( all 11-18 and people living in military collages and asplenia)
pneumococ:PCV20, PCV15 follow by PPSV23
Tdap

contra( MMR, LIVE, under 200)

23
Q

serum sickness like reaction

A

immune complex formation
AB( beta lactamn sulfa)
acute hepatitisB IMP

1-2 week after exposure
fever skin rash polyarthralgia
supportive
and steroids and plasmapheresis if very severe

24
Q

syphilis treatment

A

primary or secondary or early latent ; 2.4 im pen
latent more than 12 2.4 benz pen weekly *3

neuro ; 3-4 aqueous pen every 4 hours for two weeks

congenital; aqueous pen 50.000/kg every 8 hr for 10 days

25
when to give AB to patients with diarrhea and ..
high risk features: bloody or high dose fever, sever disease hospitalized, elderly, immunocompromised, diarrhea more than 7 days then we do stool stud ; if there was a inflammatory inf that is not shigatoxin producing then we can give AB
26
complications of diftheria
toxic mediated myocarditis , neuritis, kidney disease
27
lyme what to do
treat with clinical diagnosis, it can cause bilateral cranial nerve palsy ( like 7) it can be like bells pals
28
pneumonia treatment
inpatient ; levo or cef + azithro ICU : cef + azithro or cef+ levo outpatient; amoxi or doxy +or- macrolide
29
giardias treatmnet
tinidazole or nitazoxanide , metronidazole for children
30
adult vaccines
Tdap every 10 after 19 influenza after 19 herpes zoster after 50 2 dose at least 2 month apart more than 65 pneumo either one 20 or 15+23(after 1 year) under 65 either 20 or 15 +23(after 8 weeks)
31
HIV and one chronic inflamatory disease
after a while IRIS(immune reconstition inflammatory sundrome) fever and worsend symptomes(like in TB) nothing to be done
32
skin papules with central umbilicatio+HIV+hepatosplenomegalyand reticuloendotheliail systme maybe respiratory symptomes
cryptocucus neoformans
33
neurosyphlis
early: meningitis , ocular; posterio uveitis (most common), decreased visual acuity, ogen with meningitis, meningocular late; general paresis . Progressive dementia, tabes dorsalis ; posterio column, pipillary defect, may have normal CSF
34
antiviral therapy for influanza
under 48 hours more than 65 years pregnant to postpartum chronic disease(cardiovascular, chronic pulmonary, renal ,hepatic, immunosuppressed morbidly obese residents of nursing home or long term facilities
35
tb drugs adverse effect
rifampin(dna dependent rna polymerase); gastro, rash , red and orange body fluids, cytopenia, isoniazide*mycolic acid synthesis); neurotoxicity (B6 pyridoxine) hepatotoxicity , pyrazinamide(unclear); hepatotoxicity and hyperuricemia ethambutol (inhibition of arabinosyl transferase; optic neuropathy
36
Complications of mouth hanf foot disease
myopericarditis , aseptic meningitis, nail dystrophy
37
dengue fever
flu-like symptoms, pre orbital pain, diffuse maculopapular rash, leukopenia, positive tourniquet test (petechia after sphygmomanometer cuff inflation for 5 min), warning signs, abdominal pain persistent vomiting, fluid accumulation, mucusal bleeding, lethargy or restlessness, hepatomegaly more than 2 CM, increased hematocrit with rapidly decreasing platlate count progression: shock , respiratory distress, sever bleeding, sever organ involvement ( last alt , impaired consciousness, organ failure)
38
chemoprophylaxis
Atovaquone- proguanil Expensive,Gl disturbance (eg, abdominal pain), 1 liver function tests Doxycycline Inexpensive Gl disturbance, sun sensitivity, teratogenic Mefloquine,Neuropsychiatric effects Agent of choice in pregnancy Weekly dosing Areas with chloroquine- ine- susceptible P falciparum (in addition to options above) Chloroquine, hydroxychloroquine, Need to be started 1-2 weeks in advance, Potential exacerbation of some skin conditions Areas without P falciparum (parts of South America, Mexico, Korean peninsula) Primaquine, Potential teratogenicity, Hemolysis in patients with G6-PD deficiency
39