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Internal Medicine > Infectious > Flashcards

Infectious Flashcards

1
Q

Name the bacteria which cause acute Bacterial RHINOSINUSITIS

A

Streptococcus pneumoniae (~30%),

non-typeable Haemophilus influenzae (~30%),

Moraxella catarrhalis (~10%)

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2
Q

What are the dx features of Acute bacterial RHINOSINUSITIS?

A

Sever Symptoms with High Grade Fever, facial pain and purulent nasal discharge

OR

Persistent Sx >10 days w/o improvement

OR

Worsening Sx >5 days after initially improving Viral URTI

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3
Q

What are the finding of Sinusitis?

A

Findings of sinusitis:

sinus opacification,

mucosal thickening

and/or air fluid levels

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4
Q

Important point of acute bacterial RHINOSINUSITIS

A

Pseudomonas aeruginosa is common in nosocomial sinusitis, especially in immunocompromised patients with nasal tubes or catheters.

S.aureus may be a cause of chronic sinusitis (> 12wks) but not a cause of acute

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5
Q

What is Centor Criteria?

A

tonsillar exudates,

tender anterior cervical adenopathy

fever

and absence of cough

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6
Q

If Centor Criteria is 2-3 then what to do?

A

Do rapid strep antigen test for strep pharyngitis

If positive then give Oral penicillin Or amoxicillin

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7
Q

If Centor Criteria is 4 then what to do?

A

Do rapid strep antigen test for strep pharyngitis

If positive then give Oral penicillin Or amoxicillin

Or

Give Empiric oral penicillin Or amoxicillin

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8
Q

How Viral pharyngitis presents?

A

SxS of pharyngitis plus cough, conjunctivitis, rhinorrhea and oral ulcers

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9
Q

How bacterial pharyngitis presents?

A

Bacterial pharyngitis plus presence of exudates, edema, palatal petechiae:
And absence of viral SxS

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10
Q

What are the underlying factors in adult which increase the risk of complications due to influenza?

A

Age more than 65 with morbid obesity

Immunosuppression with native Americans

Nursing home or chronic care facility residents

Pregnant or up to 2wks of postpartum

Any co morbid

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11
Q

Name the bacteria which cause pneumonia in children and adult due to cystic fibrosis

A

S. Aureus in children

P.aeruginosa in adult

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12
Q

Triad of Retropharyngeal abscess

A

Pre existing URTI seen in children age 6 months to 6 years

With dysphagia, inability to extend neck, muffled voice and trismus

X Ray shows wide prevertebral space and prevertebral soft-tissue space should be narrower than the vertebral bodies.

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13
Q

Why incidence of Retropharyheal abscess decreases after 6 years of age?

A

Incidence ↓ after age 6 years due to a combination of retropharyngeal lymph node regression and fewer viral upper respiratory infections.

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14
Q

Triad of Toxic shock syndrome

A

Hx of use of tampons and Nasal packing

High grade fever

SxS of shock

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15
Q

What are the cause of B/L acute cervical adenitis in children?

A

Adenovirus
(LAD + pharyngoconjunctivits)

EBV/CMV
(LAD + mononucleosis)

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16
Q

Name the bacteria In children which cause U/L cervical LAD with hx of papular nodular at the site of of cat scratch Or bite

A

Bartonella henselae

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17
Q

Name the bacteria In children which cause U/L cervical LAD and Sx of periodontal diseases and dental caries

A

Anaerobic bacteria (Prevotella buccae)

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18
Q

Name the bacteria In children which cause U/L cervical LAD with pronounced erythema and tenderness

A

Staph aureus

Strept pyogenes

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19
Q

Triad of Tularemia

A

Francisella tularensis

zoonosis (rabbits, hamsters, or blood-sucking arthropods)

acute, u/l cervical LAD, fever, chills, headache, and malaise

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20
Q

Name the ABx used in different stage of Lyme diseases

A

Early localised stage:::
Oral doxycyline is the DOC for this condition in non-pregnant and pts >8 yr old.

Oral amoxicillin OR cefuroxime is given to pts <8 yrs, pregnant and lactating women

EARLY DISSEMINATED AND LATE DISEASE::
IV ceftriaxone is also very effective in early disease but it is reserved for early disseminated and late disease
used for cardiac and neurologic manifestations of Lyme disease

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21
Q

Important point of Lyme diseases

A

Serology is not recommended for early disease as it is very insensitive and usually negative

Serology however should be performed in pts with signs of early disseminated or late disease.

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22
Q

Name the drug prophylactically given in Lyme diseases

A

doxycycline

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23
Q

What are the prophylactic criteria for Lyme disease?

A

Tics attached for >36 hours or engorged

Prophylaxis started within 72 hours after after tics removal

Attach tics is adult or deer tick

Local Lyme diseases infection rate>20%

No contraindications of doxcyline

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24
Q

What is treatment and post exposure prophylactic treatment of BORDETELLA PERTUSSIS in age less than 1 month?

A

Azithromycin for 5 days

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25
Q

What is treatment and post exposure prophylactic treatment of BORDETELLA PERTUSSIS in age more than 1 month?

A

Azithromycin for 5 days

Or

Clarithromycin for 7 days

Or

Erythromycin for 14 days

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26
Q

How to dx Pertusis?

A

culture and/PCR from nasopharyngeal secretions with <1 month of Sx.

Sx >1 month require serology to confirm diagnosis

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27
Q

Triad of EHRLICHIOSIS

A

Prodromal with neurological symptoms

No rash with decrease in WBC and lymphocytes

Dx test shows intracytoplasmic morulae in monocytes

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28
Q

What is the treatment of EHRLICHIOSIS?

A

Empiric doxycycline while awaiting confirmatory testing

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29
Q

What is the gold standard test of Infective Endocarditis?

A

TEE

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30
Q

What is the common cause of death in Infective endocarditis?

A

Valvular insufficiency

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31
Q

Important point of Infective endocarditis

A

Staph infection is the MCC of health care associated Infective endocarditis

Strept infection is the MCC of community acquired infective endocarditis

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32
Q

What are the t/m options of latent TB?

A

Rifampin for 4 months

Isoniazid and rifampin for 4 months

Isoniazid monotherapy for 6-9 months

Isoniazid and rifapentine weekly for 3 months under DOT

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33
Q

What are the patient whom to treat if PPD is >5mm?

A

HIV +ve patient

Recent contact of known TB

Nodular or fibrotic changes on CXR consistent with previously healed TB

Organ transplant patient with immunosuppression

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34
Q

What are the patient whom to treat if PPD is >10mm?

A

Recent immigrants from Tb endemic area

Injection drug users

Working in high risk setting

TB lab worker

Higher risk for Tb reactivation

Child age less than 4 yrs of age OR those exposed to adults in high risk categories

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35
Q

How to give medications of active pulmonary Tb?

A

RIPE for 2 months

Then R and I for 4 months

So total 6 months

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36
Q

Name the empiric Abx for Infective Endocarditis

A

Vancomycin in most cases

Empiric therapy in a native valve should cover methicillin susceptible and methicillin resistant staph, strep and enterococci

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37
Q

Name the STDs organisms whose initial lesion is painful

A

Haemophilus ducreyi

HSV 1/2

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38
Q

How organisms arrange in Haemophilus ducreyi?

A

Clump in long parallel strands (school of fish)

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39
Q

Name the STDs which presents with ulcer without LAD

A

Klebsiella granulomatosis

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40
Q

What is the MCC of mucopurulent cervicitis?

A

Most common cause of mucopurulent cervicitis is Chlamydia trachomatis, followed by N. gonorrhoea

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41
Q

Name the test which d/f Chlamydia trachomatis and N. gonorrhea

A

NAAT more sensitive than gram staining

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42
Q

Important point

A

Non fungal organisms causing vaginal discharge will have normal pH Viz gardnerella and Trichomoniasis

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43
Q

Triad of PHYSIOLOGIC LEUKORRHEA

A

Copious white or yellow discharge, non-malodorous

No abnormality on physical exam

Microscopic exam may show squamous cells and polymorphous leukocytes

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44
Q

What are the t/m regimes for syphilis in d/f stages?

A

Primary:::
IM penicillin G—->if allergic then give doxycycline 14 days

2nd:::
IM penicillin G—->if allergic then give doxycycline 14 days

Latent::
IM 2 doses penicillin G—->if allergic then give doxycycline 28 days

Tertiary:::
IM 14 days penicillin G—->if allergic then give ceftriaxone 14 days

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45
Q

Name the test specific for syphilis

A

Non-treponemal (RPR/VDRL)::
-ve result in early infection
Quantitative
Decrease in titers confirm treatment

treponemal(FTA ABS / TP/EIA)::
Greater sensitivity in early infection
Qualitative
Positive even after treatment

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46
Q

Important point of syphilis

A

Treatment empirically it even negative screening serology but strong clinical evidence of primary syphilis

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47
Q

What to check if there is recurrent DISSEMINATED GONOCOCCAL INFECTION?

A

Terminal complement activity

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48
Q

How to t/m DISSEMINATED GONOCOCCAL INFECTION?

A

IV ceftriaxone 1g/day for 14 days—>then switch to PO cefixime when clinically improved

Also give medicine against chlamdiya

T/m sexual partners too

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49
Q

Triad of PID

A

Fever with Purulent cervical discharge

Adnexal tenderness and Cervical motion tenderness

Lower abdominal tenderness

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50
Q

What are the complications of PID?

Remember:: TAPS

A

Tubo-ovarian abscess

Abscess rupture

Pelvic peritonitis

Sepsis

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51
Q

What are the t/m options for PID?

A

Hospitalised Patient:::
cefoxitin or cefotetan/doxycycline and clindamycin/gentamicin (all IV) Hospitalization

non-hospitalized patients:::
IM cefoxitin + oral probenecid and oral doxycycline,

or IM ceftriaxone and oral doxycycline.

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52
Q

What are the causes/ Risk factors for VULVOVAGINITIS IN PREPUBERTAL CHILDREN?

A

infections, congenital abnormalities, trauma,
dermatological conditions

lack of labial development,
unestrogenized thin mucosa
poor hygiene / bubble baths
shampoos, obesity and certain choices of clothing.

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53
Q

What are the causes of Neonatal conjunctivitis on the basis of age of onset?

A

Chemical induced occur less than 24 hours

Gonococcal induced occur with 2-5 days after birth

Chlamydial induced occur with 5-14 days after birth

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54
Q

Triad of chlamydial induced conjunctivitis

A

Occur after 5-14 days after birth

Discharge (watery/bloody/mucopurulent) with eye swelling and chemosis

T/m is oral erythromycin

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55
Q

Triad of Gonococcal conjunctivitis

A

Occur with 2-5 days after birth

Marked eye swelling with profuse purulent discharge

IV OR IM ceftriaxone / Cefotaxime

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56
Q

What is the best Rx to dx the cause of urethritis?

A

NAAT

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57
Q

What is the t/m of uncomplicated pyelonephritis?

A

Mild to moderate= Septran-DS/Quinolones

Severe= Ceftriaxone / Septran-DS / Quinolone

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58
Q

What is the t/m of complicated pyelonephritis?

A

Mild to moderate= ceftriaxone / cefepime /Quinolones

Severe = ampicillin-sulbactam / Tanzo / mero / imipenem /azteronam

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59
Q

Name the organism in which vomiting pre-dominant in foodborne diseases

A

Staph-aureus

Bacillus Cerus

Noroviruses

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60
Q

Name the organism in which diarrhoea pre-dominant in foodborne diseases

A

C-perfringens

E. coli

Enteric virus

Cryptosporidium

Cyclospora

Intestinal tapeworm

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61
Q

What is the source of c-perfringens?

A

Associated with undercooked Or unrefrigerated food

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62
Q

Name the bugs causing travellers diarrhoea with long term illness (>2 wks)

A

Giardia

Cyclospora

Cryptosporidium

Cystoisospora

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63
Q

Name the bugs causing travellers diarrhoea with short term illness

A

Rotavirus/ norovirus

E. coli

Campylobacter

Salmonella

Shigella

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64
Q

How to dx C.Difficile colitis?

A

PCR detection of toxin gene In stool

Or

Enzyme immunoassay

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65
Q

Triad of mil-moderate C-difficile colitis

A

WBC <15k

Cr less than 1.5 time baseline

T/m metronidazole

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66
Q

Triad of Severe C-difficile

A

WBC >15k with Cr >1.5 time baselines and serum albumin <2.5g/dL

Give oral vancomycin

If ileus —> then add IV metronidazole and switch to rectal vancomycin

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67
Q

Important point of c-difficile colitis

A

Fidaxomicin is a bactericidal antibiotic usually reserved for recurrent colitis or as initial therapy for patients with severe colitis who cannot tolerate oral vancomycin

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68
Q

What is neutropenia?

A

Neutropenia is defined as absolute neutrophil count <1500/uL (severe neutropenia is <500/uL)

Monotherapy with anti-pseudomonal beta lactam antibiotic (e.g. cefepime, meropenem, piperacillintazobactem) provide both Gram+ and -ve coverage and is recommended initially.

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69
Q

How to d/f EBV and Group A strep pharyngitis?

A

EBV::
Tonsillar exudates
Fever with diffuse cervical LAD
HSM

Group A strep pharyngitis::
Tonsillar exudates
Fever with anterior cervical LAD
No HSM

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70
Q

Triad of aphthous stomatitis

A

No fever

No systemic symptoms

Recurrent ulcers on anterior oral mucosa

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71
Q

What is the d/f between herpangina and herpetic stomatitis?

A

HERANGINA::
Due to coxsackie A virus
Fever
Vesicles & ulcer on posterior oropharynx

HERPETIC::
Due to HSV 1
Fever
Vesicles & ulcers on anterior oral mucosa and around mouth

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72
Q

Name the organism which cause meningitis in age group of 2-50 years

A

N.meninigitis

S.pneumonia

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73
Q

Name the organism which cause meningitis in age group of >50 years

A

N.meninigitis

S.pneumonia

Listeria

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74
Q

Name the organism which cause meningitis in patient with Neurosurgery/shunt

A

Gram negative rods

S aureus

Coagulase -ve staphylococcus

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75
Q

Name the organism which cause meningitis in immunocompromised patient

A

Listeria

N meningitis

Pneumococcus

Gram -ve rods

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76
Q

Name the organism which cause meningitis with trauma to head

A

S aureus

Gram -ve rods

Coagulase -ve staphylococcus

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77
Q

Triad of meningococcal meningitis

A

Fever with SxS of meningitis

Petechial/purpuric rash

Multi organ failure viz adrenal haemorrhage

78
Q

Important of meningitis

A

In neonates =28 days, give cefotaxime instead of ceftriaxone as it displaces bilirubin from albumin and ↑ risk of kernicterus.

This is not the case in children > 28 days as hyperbilirubinemia is unlikely

79
Q

What is neonatal sepsis?

A

Systemic bacterial infection that occurs in infants <28 days old

80
Q

Important point of neonatal sepsis

A

Group B staph is most common in term neonates

and

E. coli in preterm neonates

81
Q

Name the cause of neonatal sepsis which occur due to inDWELLING IV catheter

A

Coagulase negative staphylococcus

82
Q

Name the cause of neonatal sepsis which has association with skin / bone / or joint infection

A

Staphylococcus aureus

83
Q

Important point of neonatal sepsis

A

Neutrophilia with a significant left shift (bands of >700/µL or a band to total neutrophil count ratio >0.16) usually indicates neonatal sepsis from bacterial infection.

84
Q

Name the bacteria causing Septic arthritis from birth to 3 months

And

How to t/m them?

A

Staphylococcus/ Group B streptococcus and gram -ve bacilli

Abx: antiStaphylococcus agents (nafcillin Or vancomycin)
Plus Gentamycin or Cefotaxime

85
Q

Name the bacteria causing Septic arthritis in older than 3 months

And

How to t/m them?

A

Staphylococcus/ Group A streptococcus and strep- pneumonia

Nafcillin / clindamycin
Cefazolin / vancomycin

86
Q

Important point of septic arthritis

A

Debridement and irrigation of joint space is the most important intervention in preventing long-term disability.

even a delay of 4-6 hours can lead to femoral head necrosis

87
Q

Important point of septic arthritis

A

If the patient remains febrile or fails to improve after arthrocentesis and 48 hours of appropriate antibiotic therapy,

MRI should be performed to evaluate for concomitant osteomyelitis

88
Q

Difference between Early and late onset prosthetic joint infection

A

Early:::
Within 3months of Primary arthroplasty
Wound drainage, erythema, swelling often with fever
Implant removal/exchange, may consider debridement and implant retention

Late::
>3 months of primary arthroplasty
Sinus tract formation /implant loosening / persistent joint pain
Implant removal /exchange generally recommended

89
Q

Name the organism causing EARLY ONSET PROSTHETIC JOINT INFECTION (less than 3 months)

A

S.aureus

Gram negative rod

Anaerobes

90
Q

Name the bacteria causing late onset prosthetic joint infection

A

Coagulase -ve staphylococcus

Propionibacterium Species

Enterococcus

S-epidermis

91
Q

Triad of CAT SCRATCH DISEASE

A

Bartonella henselae

Papule at scratch /bite site with LAD and fever

Azomax recommended in disseminated disease Or for immunocompromised hosts

92
Q

Triad of Nocardia

A

Sxs Mimics like Tb

fever with FNDs due to brain abscess

Tx are Spetran-ds and meropenem, linezolid as alternate.

93
Q

Important point of Actinomycosis

A

Clindamycin is an alternative for pts allergic to pencillin

94
Q

Triad of Legionella

A

High Grade fever with bradycardia

Neurological and GIT Sx like diarrhea

Sputum gram stain showing many neutrophils but few or no micro-organisms.

95
Q

Name the diagnostic test for Legionella

A

urine antigen test and culture from bronchoscopy

96
Q

What is VAP?

A

VAP is a type of nosocomial pneumonia that usually develop >48 hours after intubation.

97
Q

Name the cause of OSTEOMYELITIS in less than 2months of age.

A

Group B strept /E coli

98
Q

Name the cause of OSTEOMYELITIS in 2months-4yrs of age.

A

kingella kingae

99
Q

Name the cause of OSTEOMYELITIS in age more than 4 years

A

staphl aureus

100
Q

Name the cause of OSTEOMYELITIS in patient with UTI or urinary tract instrumentation

A

P. aeruginosa and Klebsiella

101
Q

Name the cause of OSTEOMYELITIS in patient with hx of NAIL PUNCTURE WOUND.

A

P. aeruginosa

102
Q

What are the diabetic foot factors which progress to OSTEOMYELITIS?

A

Long standing wounds with Sxs

Large ulcer size (>2cm) with increase ESR

presence or paplation of bone in the ulcer base.

103
Q

What is the most reliable sign of vertebral OSTEOMYELITIS?

A

Exquisite focal tenderness on percussion at the posterior spinous process of the
affected vertebra,
increased muscle spasm in the contiguous area,
and decreased range of motion in the back.

104
Q

Important point of imaging of vertebral OSTEOMYELITIS

A

(MRI) is the modality of choice for patients with suspected vertebral osteomyelitis. It can also detect epidural abscess and cord compression.

Radionuclide bone scanning using gallium is an alternate for patients who can’t undergo MRI.

Computed tomography (CT)-guided aspiration and culture of infected intervertebral disc space or bone are needed to confirm the diagnosis.

105
Q

Triad of Ameboic liver abscess

A

Hx of dysentry prior to RUQ pain

fever with RUQ pain

Serologic testing for E. histolytica confirms the diagnosis.

106
Q

How to t/m ambeoic liver abscess?

A

Metronidazole is the DOC for amebic liver abscess

paromomycin is also used for eradication of intestinal infection

Drainage is done when there is mass effect, imminent rupture, no response to therapy or when diagnosis is uncertain.

107
Q

Triad of fetal infeection due to TOXOPLASMA GONDII

A

microcephaly with microphthalmia

chorioretinitis with diffuse petechiae

intracranial calcifications

108
Q

Name the antimalarial medications given in area with chloroquine susceptible P falciparum

A

Chloroquine

Hyrdoxychloroquine

109
Q

Name the antimalarial medications given in area with chloroquine resistance P falciparum.

A

atovaquone-proguanil
doxycycline
Mefloquine

110
Q

Name the antimalarial medication safe in pregnancy

.

A

Mefloquine

111
Q

what will be seen in peripheral blood smear of BABESIOSIS?

A

Thin blood smear->Ring inside RBCs (maltese cross)

112
Q

Name the parasite causing cutaneous larva migrans

A

Hookworm larvae

113
Q

Triad of Cutaneous larvae migrans

A

hx of barefoot walk viz at sea side

intensely pruritic, migrating, serpiginous reddish brown track

Normal count of eosinophils in CBC

114
Q

Triad of TRICHINELLOSIS

A

myalgias
periorbital edema
eosinophilia

115
Q

Name the sensitive and specific test for HISTOPLASMOSIS

A

Urine Or Serum Antigen

116
Q

How to t/m Histoplasmosis?

A

Mild to moderate Pulmonary infection in Immunocompetent:: No t/m OR Itracanzole

Severe / Immunocompromised/disseminated disease:: Amphotericin followed by Itracanzole

117
Q

Important point of Histoplasmosis

A

Histoplasmosis should be considered when a pt with suspected sarcoidosis deteriorates following immunosuppressive therapy.

118
Q

What’s the presentation of Rash of BLASTOMYCOSIS?

A

Skin lesions have a characteristic presentation of heaped up verrucous or nodular lesions with a violaceous hue that may evolve in to microabscesses.

119
Q

What’s the t/m of BLASTOMYCOSIS?

A

Mild pulmonary disease in Immunocompetent host:: not need of t/m

Mild to moderate Pulmonary disease with mild dissemination:: PO Itracanzole

Severe / immunocompromised/severe dissemination:: IV amphotericin

120
Q

Name the medication for CRYPTOCOCCAL MENINGOENCEPHALITIS

A

Amphotericin B with flucytosine with fluconazole as maintenance drug

121
Q

What are the alternate regimen for the PCP beside Septran-DS?

A

IV pentamidine
Atovaquone
TMP-Dapsone
Clindamycin+primaquine

122
Q

Important point

A

Anti-retroviral treatment is started after PCP treatment to reduce drug interaction, pill burden and risk of immune reconstitution syndrome

123
Q

What are the risk factors for neonatal HSV infection?

A

Primary maternal infection & Preterm birth
Longer duration of rupture of membranes
Vaginal delivery with active lesions
Impaired skin barrier as fetal scalp electrodes

124
Q

What are the indications of C-section in HSV infection?

A

All women who are in labor with active genital HSV lesions or prodromal symptoms
And
With positive Hx–>should receive prophylactic acyclovir or valacyclovir beginning at 36 weeks of pregnancy

125
Q

What is the PEP management of varicella if patient has positive Hx of VZV?

A

Observation

126
Q

What is the PEP management of varicella if patient has negative Hx of VZV?

A

If immunocompromised–>immunoglobulin within 10days of exposure
If Immunocompetent–>varicella vaccine

127
Q

How CMV presentation d/f from rubella?

A

Deafness is u/l in CMV with Blindness due to chorioretinitis and Heart is unaffected.

128
Q

Name the test to dx b19 virus?

A

NAAT in immunocompromised

B19 IgM Ab in Immunocompetent

129
Q

How to test for reactivation of previous b19 virus?

A

NAAT to detect b19 virus

130
Q

Triad of CHIKUNGUNYA FEVER

A

Fever with pain multiple joints

Maculopapular rash with LAD

Decrease in lympho with PLT and increase in LFT

131
Q

How Croup patient presents?

A

Inspiratory strider with barking

cough seal like in age 6months to 3 years

Hoarse voice
Steeple sign on CXR

132
Q

How to t/m croup?

A

Mild (no stridor at rest) ::: steroids

Moderate/severe (stridor at rest) ::: steroid and Nebs with epinephrine

Endotracheal intubation if above method fails and patient also deranged

133
Q

How rabies infected patients present?

A

Paralytic—>ascending flaccid paralysis

Encephalitis SxS with hydrophobia

134
Q

When to suspect patient is having acute flare of chronic HBV?

A

HbSAg and HBV DNA positive
AntiHbc IgM and IgG positive
HbeAg likely positive

135
Q

Define Window period in Hepatitis B?

A

Window period:

time lag between disappearance of HBs antigen and appearance of anti-HBs

136
Q

Name the medication for Hepatitis B

A

Interferon->short term t/m in younger patient with compensated liver disease
Lamivudine:: limit

137
Q

Cause of Post operative fever

A

Wound—>surgical site infection
Wind—>PE / pneumonia / aspiration

Water—>UTI
Walk—>DVT
Wonder drugs

138
Q

Cause of Post op fever within 2hrs

A

Blood products
Malignant hyperthermia
Prior Trauma OR infection

139
Q

Cause of Post op fever after 24hr but within 1wk (ACUTE)

A

If non infections—>PE / DVT / MI

If infection—>Group A strept OR C.perfingens (SSI)

140
Q

Cause of Post op fever after 1wk but within less than 1month (sub ACUTE)

A

If non infection—>drug /DVT /PE

If infection—>c.difficle / SSI / catheter site infection

141
Q

Cause of Post op fever after 1 month

A

SSI due to indolent infection

Viral infections

142
Q

How to do screening of HIV infection?

A

HIV p24 antigen and HIV antibodies—>if positive—>HIV1/2 antibody

143
Q

Important point of HIV

A

Plasma HIV RNA testing is recommended for those with –ve serologic testing and high clinical suspicion of acute HIV

144
Q

Name the ART causing myopathy

A

Integrase Inhibitors (“Gravir”)

145
Q

Name the ART causing lipid dystrophy , dyslipidemia and insulin resistance

A

Protease Inhibitors (NAVIR)

146
Q

Name the ppx med for PCP

A

If CD count less than 200—->TMX-SM

147
Q

Name the ppx med for histoplasmosis

A

If CD count less than 150—>Itraconazole

148
Q

Name the ppx med for toxoplasmosis

A

If CD count less than 100—>TMX-SM

149
Q

Name the ppx med for MAC

A

If CD count less than 50—>AZOMAX

150
Q

Name the organisms causing Diarrhea in HIV

A

CMV and MAC
Cryptosporidium
Microspordium / isospordium

151
Q

what organisms causing watery diarrhoea HIV

A

All three except CMV—>it causes bloody Diarrhea

152
Q

Classified the HIV induced diarrhea on the basis of CT count

A

MAC and CMV— less than 50
Cryptosporidium—>Less than 180
Microspordium / isospordium —> less than 100

153
Q

What to do if patient received more than 3 doses of tetanus toxoid?

A

No TIG regardless of wound is dirty or clean

Give tetanus toxoid containing vaccine only

154
Q

What to do if patient received less than 3 doses of tetanus toxoid or immune status in unknown Or unimmunized ?

A

> TT vaccine in both dirty or clean wound

But TIG only in dirty Or severe wound

155
Q

Whom to Give PED HIV drugs?

A

Exposure of Blood or body fluid mixed with blood

Or

Exposure of mucous membrane, non intact skin or percutaneous exposure

156
Q

Name the PEP drugs in HIV

A

The prefer meds are Tenofovir-Emtricitabine and Raltegravir

Otherwise Two nucleotides/nucleoside and other HIV meds

157
Q

What are the risk Factors of HIV in infancy?

A

Breast feeding by infected mother

High maternal viral load

158
Q

Name the extra hepatic manifestation of HCV

A

Increase risk of diabetes

P.cutanea tarda, lichen planus

Membranoproliferative glomerulonephritis

Essential mixed cryoglobulinemia

159
Q

Name the vaccine given in HIV patients

A

HBV if not immunised
Flu annually

N.meningitis in all age groups
TDap follow be booster dose afte a decade

HPV in 11-26 yrs only
Strep.Pnuemonia PCV13 followed by PPSV 23

160
Q

Whom to give HAV vaccine in HIV?

A

Homesexual

IVDU

CLD due to HBV and HCV

161
Q

Important point Of HIV and vaccine

A

All live vaccine are contraindicated if CD count less than 200

162
Q

Name the factors which increase the risk of VAP

A

Supine position
Acid suppression

Excessive patient movement and vent setting alteration
Pool sub glottic secretions

Excessive use of paralytics and sedations

163
Q

How can the risk of VAP decrease?

A

Bed elevation
Frequent suctioning

Minimal alteration of vent settings
Limited used of gastric acid suppressors

Minimal movement of patient

164
Q

Name the vaccine given in CLD patients

A

Flu annually
Strep.Pnemonia vaccine

HAV and HBV
TDaP

165
Q

Name the vaccine given in Asplenic patient

A

Strep.pneumonia
H.Influenza

N.meningitis
Flu

HAV HBV
TDaP

166
Q

What is the recommended age for N.meningitis vaccine?

A

At age 11-12 yrs

Booster at age 16-21 if primary vaccination at age less than 16 yrs

167
Q

Name the condition in which vaccine given against N.meningitis even after 18 years of age

A

Complement deficiency
Asplenia

College students or military
Travel to endemic area

168
Q

What are the contraindications of Rota virus vaccine?

A

Hx of Intussusception
Anaphylaxis to vaccine ingredients

SCID
Hx of un correct congenital GIT structures

169
Q

What are the contraindications of DTaP?

A

Anaphylaxis hx

In case of pertusis—> Progressive NEUROLOGIC disorder and
Encephalopathy with previous dose

170
Q

Name the STI which shows MULTIPLE small group ulcer with shallow Erythematous Base

A

HSV

171
Q

Name the STI which have MULTIPLE deep ulcers with irregular borders and shows gray yellow exudates

A

H.Ducreyi

172
Q

Name the STI which show single indurated ulcer with clean base

A

Syphils

173
Q

Name the STI which shows small and shallow ulcers with fluid filled swelling of Lad (buboes)

A

Chlamydia

174
Q

Important point of HIV associated dysphagia

A

Odynophagia without dysphagia seen in virus such as CMV and Herpes

Dysphagia± odynophagia —> Candidia

175
Q

What to do if patient has positive screening test of TB?

A

Get CXR and decide Latent Vs active Tb

176
Q

What does mean by latent TB?

A

Positive screening test with negative CXR and asymptomatic Patient

177
Q

Triad of Lung Abscess

A

Fever with night sweats and Wt loss

Putrid sputum in cough

Cavitary imaging with air fluid levels on imaging

178
Q

How to treat lung abscess?

A

Mero / sulbactum / Imipenem

Alternative—-> Clindamycin
No use of culture as condition cause by multiple bacteria

179
Q

Important point CAT bite and scratch

A

Cat bite leads to pasturella which t/m via augmentin

Cat scratch leads to bartonella which t/m via azomax

180
Q

How to approach Rabies PEP if bitten by PETS like dog, Cat or ferret?

A

Is animal available for Quarantine?

If no—-> stat PEP

If yes—-> 10 days observation and No PEP if animal is healthy

181
Q

How to approach Rabies PEP if bitten by high risk wild animal like bat, racoons, shunk, fox and coyote?

A

Is animal available for testing?

If no —-> stat PEP

If yes—-> Euthanize and test; if test positive give PEP

182
Q

How to How to approach Rabies PEP if bitten by (1) low risk animal like rabit rat mouse chipmunk and Squirrel
or (2) livestock or unknown wild animal?

A

First case—> NO PEP

2nd case —-> contact public health department

183
Q

Name the organism causing DELAYED ONSET PROSTHETIC JOINT INFECTION (3-12 months)

Typical sxs like No fever or increase WBC but implant loosening or sinus tract formation

A

Coagulase negative staphylococci (epidermis)

Enterococci

Propionibacterium species

184
Q

Name the organism causing LATE ONSET PROSTHETIC JOINT INFECTION ( >12 months)

Patient had Infection at distant site then bacteria infects joints via blood

A

S.aureus

Gram negative rod

B-Hemolytic strep

185
Q

What are the risk Factors of Splenic Abscess?

HIT

A

H hemoglobinopathy like Sickle cell dis

I IV drug abuser ; Immunosuppression; Infection like Infective Endocarditis which spread via blood

T trauma

186
Q

Triad of Splenic Abscess

A

Fever

LUQ pain with left sided pleuritic chest pain

Increase WBC count with pleural effusion

187
Q

How to dx and manage Splenic Abscess?

A

Dx via CT scan

Tx viz ABx with removal of spleen
Or
percutaneous drainage in poor surgical candidates

188
Q

What are the causes of Meningitis in less than 1 month baby?

A

GBS
E. coli and other gram -ve

Listeria
HSV

189
Q

What are the causes of meningitis in more than 1 month baby?

A

Strept-pneumonia

N-meningitis

190
Q

How to manage suspected Or confirmed flu Infection?

A

1) If w/o risk Factor for it complications—>no testing and symptomatic tx
2) If with risk Factor ( like age ≥65 yrs, Comorbids, pregnancy) or those without riskf factor reach hospital within 48 hrs —> Osetlamivir

191
Q

How Lemierre Syndrome present?

Cause is fusobacterium Necrophorum

A

Oropharyngeal sxs sore throat, dysphagia, fever or neck pain and swelling
(due non exudative tonsillitis or pharyngitis)

Follow by involvement of neurovascular structures like internal jugular vein thrombosis—>septic emboli form which particularly involved lungs

192
Q

How to dx and t/m Lemierre Syndrome?

A

Culture of Blood or pus

Tx:
IV Abx with airway secured
Surgery incase of refractory to Abx

Internal Medicine (14 decks)

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