Infectious Disease Flashcards
What are the side affects of penicillin?
HSR, rash, angioedema, AIN, and serum scikness
What are the side affects of TMP-SMX?
Folate deficiency,
What are the side affects of doxycycline?
Pill esophagitis, and tooth discoloration
What are the side affects of linezolid?
Thrombocytopenia, and serotonin syndrome
What are the side affects of floroquinolone?
Tenosynovitis
What are the side affects of second generation cephalosporins (ie cefotetan)
Disulfiram- like reaction
What are the side affects of Vancomycin?
Renal toxicity, Red Man syndrome (administering the drug too quickly),
What are the most common causes of infection for impetigo.
Beta hemolytic (Group A) strep and staph
What is the most common cause of infection for Erysipelas?
Beta hemolytic strep (group A) strep pyogenes
What is the most common cause of infection for cellulitis?
Beta hemolytic (Group A) Strep and Staph. A
What is the Tx for impetigo?
Mupirocin if mild infection and if severe ampicillin
What is the treatment for erysipelas?
Mild amoxicillin or penicillin, if severe ceftriaxone or cephazolin
What is the tx for non- purulent cellulitis?
for mild presentation cefalexin, for those patients with MRSA resistance consider TMP-SMX, Amoxicillin + doxycycline. For severe IV cefazolin for patients with MRSA risk Vancomycin and ceftarolin.
How to treat a patient with non- purulent cellulitis?
For mild infection that does not require coverage of Strep. doxycycline. For patients that may have an artifical valve then consider Vanc or daptomycin, doxycycline + amoxicillin or TMP SMX
What is the most common cause of Necrotizing fascitis?
polymicrobial or strep pyogenes
What are the most common causes of Gas gangrene?
C. perfringens, C.histolyticum
What is the most common cause of TSS?
Staph. Areus
What is the treatment for TSS?
Remove the foregin body (either clindamycin + oxacillin or vancomycin
What is the treatment for Necrotizing fascitis
Vancomycin + pipercillan tazobactam + clindamycin.
What is the treatment for GAS gangrene?
penicillin + clindamycin
In patients with diabetic foot ulcers what additional workup should be done to be cautious of further disease development?
Get an X-ray specifically if the ESR is elevated, the bone exposure on probe, ulcer is > 2cm, and duration of ulcer is >1-2 weeks
In general in adults the most common causes of Meningitis are?
Strep. pneumonia, H.In, Nisseria Meningitis,Listeria coverage of antibiotics should be catered
What is the most common cause of meningtis in a patient that is <1 month old
Strep. A, Listeria. M, and Uropathogenic E. Coli
What is the most common cause of meningitis in a child that 1-2 months old
Strep. pneumonia
What is the mcc cause of meningitis in 2 yo - 21 yo
Nisseria. M and Strep. Pneumoniae
> 21 yo what is the most common cause of meningitis?
Strep. Pneumoniae, H.In, Moraxella
What is the most common cause of meningitis in a patient with HIV?
Strep. pneumonia and cryptococcus is possible but not the most common
What is the most common cause of meningitis in a patient with placentment of ventriculoparitoneal shunt?
Staph. Epidermidi
What are the most common causes of encephalitis?
HSV, Aboviruses (west nile, wastern equine), enteroviruses (coxsackieviruses, echoviruses, polioviruses, and the hepatitis A virus.)
What is the coverage for bacterial meningits in a patient that is <1 month
Amp (covers listeria), Gentamicin (also covers gram negatives) and cefotaxime (covers E.coli)
What is the abx coverage for bacterial meningits in a patient that is 2-50 yo?
Vancomycin (pneumococal resistance to ceftrixone) + ceftriaxone (cannot be given to infants because it can cause biliary stasis)+ cefotaxime + Ampicillin
Patient that went on a hiking trip in Boston is complaining of headache and a target rash. Lumbar puncture shows heavy lymphocytes. What is the treatment for this patient?
(lyme disease) ceftriaxone
Patient that went on a hiking trip in in Carolina and is complaining of headache and a rash that started behind his ear and now diffusely spread over his body. Lumbar puncture shows heavy lymphocytes. What is the treatment for this patient?
(R.R) doxycline
Patietn with a + HIV status presents to the clinic with headache. India ink stain is positive what is the treatemnt for this patient?
(Cryptococcus .N) Amphotercin B and Flucytosine
Pt that has history of miliary tuberculosis presents with nunchal rigidity and photophobia. Lumbar puncture shows lymphocytosis what is the treatment regimen for this patient?
(TB meningitis) RIPE + steriods
Meningitis + petechiae+ purpura
N.M
Meningits + only petechia (no purpura)
Ricketssia
What is the treatment for a patient with AMS and recent onset of temporal seizure?
Acyclovir (meningoencephalitis caused my herpes virus)
What is the most common cause of viral meningitis?
arboviruses
What antibiotic covers most Strep infections
Penicillins
What antibiotics primarily cover sensitive peniclliniase Staph?
Narrow spectrum dicloxacillin (oral), oxacillin, methacillin
What antibiotics cover methicillin resistant Staph?
Vancomycin
What organisms does Amp/Amoxicillin cover?
Listeria, H.In, salmonella, moraxella , H. pylori
What 1st generation cephalosporin is oral?
Cephalexin
3rd generation cephalosporins cover?
E. Coli, Kleb, Proteus, Hin, and Moraxella
Which third generation cephalsporin covers pseudomonas?
ceftazidime
What is the fourth generation cephalosporin that covers pseudomonas?
Cefipime
What other drug class is a broad spectrum antibiotic that covers everything?
pipercillin and tazobactam
What antibiotics in addition to clindamycin and metronidazole cover anaerobic infections?
Amoxicillin clauvulanate (penicillin + penicillinase)
Carbapenems are reliable for _____ coverage (mupirocin)
Broad spectrum coverage
What are the most common causes of exudative pharyngitis?
EBV and Strep
If you suspect that a patient has a viral upper/lower respiratory tract infection what diagnostic test would you get?
PCR
If you suspect a patient has EBV what is the diagnostic work up
r/o Strep infection with a rapid strep test. CBC with peripheral blood smear and a monospot test
A patient presents to your office with fever and cough a CXR is obtained and is showing air fluid level?
get a CXR
A patient presents to your office with fever and cough you order a CXR and the CXR shows infiltrates, what is the next step in managment?
CURB-65 assess whether this patient should be hospitalized or not. Obtain blood culture before administering empiric antibiotics
What does CURB-65 stand for?
Confusion
Urea >20
RR: 30 min
B/p: systolic <90
What is the scoring system for CURB-65
If the score is 3-5 this requires ICU admission, if the score is 1-2 in patient admission, if 0 outpatient
What is the treatment for a patient with pneumonia outpatient
Azithromycin or doxycycline
What is the treatment for a patient with pneumonia inpatient?
3rd gen cephalosporin + macrolide or doxy, beta lactam + beta lactamase or a quinlones
A patient with recurrent pneumonia in the same lobe should be worked up for?
Ct scan to determine if there is an obstructive mass
What is the difference between aspiration pneumonitis and aspiration pneumonia?
Aspiration pneumonitis has sterile gastric fluid content in the airway the patient may have low grade fever and small infiltrates, but they resolve in a matter of days. Where as the patient with aspiration pneumonia swallow anaerobic organisms and causes infection.
What is the most likely location for aspiration pneumonia to occur?
posterior segment of the right upper lobe
What are good treatments for aspiration pneumonia?
Amoxicillin clavulanate , or metronidazole + cefdinir
What are treatments for patients that have community acquired pneumonia?
Ceftriaxone + azithromycin, cefdinir and doxycycline
What are the treatments for HAP?
Vancomycin (high risk for MRSA) , cefipime
Atypical organisms like legionella, mycoplasma, and chlamydia are covered by what antibiotics
Macrolides, doxycyline, and quinolones
These risks put patients at high risk of methicillin resistance.
IV drug use, HIV +, recent antibiotic therapy,
If a patient had a recent dental extraction what bug would likely cause endocarditis?
Strep Viridans
What are the organisms associated with strep viridans?
Strep mutans, strep sanguis, strep mitis, strep salivarius
Pt. has history of lower GI or Urogenital tract manipulation what bug would most likely cause endocarditis?
Enetrococus faecalis
What organism would cause endocarditis in a patient 2 months after replacement of a prosthetic device?
S epidermidis (tends to be penicillin resistant)
What organism would cause endocarditis in a patient 2 months after placement of a prosthetic device?
strep viridans
what organism would cause endocarditis in an IV drug user?
Staph. Areus (typically tends to be methicillin resistant)
What are common gram negative infections
HAECK (Haemophilus, actinobacillus, cardiobacterium , eikenella, and kingella
what organism would cause endocarditis in a with colon cancer or liver dzz
strep bovis
Pts with strep bovis should undergo what screening procedure?
colonoscopy
What are the most common murmurs in infective endocarditis?
Mitral regurgitation
What are the most common murmurs in IV drug users
tricuspid regurg
What is the empiric antibiotic for endocarditis?
Vancomycin + (gentamicin or cefipime in patients with prosthetic heart valves )
An infant that is 1 month old has been exposed to VZV (chicken pox, but there mother was never vaccinated prior to pregnancy, what is the best next step in management to protect the child from a possible chickenpox outbreak?
VZV immunoglobulin
What is the most common cause of subacute endocardits?
Strep Viridans
What is the most common cause of acute endocarditis?
Staph
What is the difference in presentation of subacute endocarditis and acute endocarditis?
Subacute is a slow onset -progressive disease presentation of fevers whereas acute the patients presentation gets worse within a couple of days.
Central venous catheters, surgical implants, and medical devices (e.g., pacemakers, ICDs are covered in what organism?
Staph E
What is the treatment for HAEK endocarditis?
ceftriaxone
What is the treatment for Whipple’s disease?
TMP-SMX
Amiodarone in addition to causing pulmonary fibrosis also has what other side affects?
Hepatoxicity
Why is norepinephrine not administered to someone in hypovolemic shock?
Although it can be used in patients with hypotensive or cardiogenic shock. Vasoconstriction won’t fix the problem of hypovolemia. That means fluids and a transfusion are the next steps in managment.
What should we consider when giving a prophylactic antibiotic prior to surgery?
- Is the patient at high risk
a. Pt have a prosthetic valve?
b. Previous history of endocarditis
c. unrepaired congenital defect
d. Repair of a cardiac defect 6mos
e. residual cardiac defect - Is it a high risk procedure
a. dental procedure
b. incision or biopsy of the mucosa
c. GI or GU infection in patients with an ongoing infection
d. procedures in a patient with an infection
What are alarm symptoms associated with diarrhea?
diarrhea through the night, bloody, immunosuppression, recent antibiotic use.
Diarrhea that last for < 1week is caused by ______ until proven otherwise?
Infection
Diarrhea that is as a result of domestic animal contact
Camp. J
New onset of diarrhea after returing from an endemic area?
Vibrio Chlorea
New onset of diarrhea after shellfish ingestion?
Vibrio Vulnificans or parahemolyticus
What is the most common cause of C. Diff diarrhea?
antibiotic use
What kind of percautions should we have with a c.diff patient?
Gown, gloves, and *washing hands
What is the treatment for C.diff
Vancomycin
When should we screen a patient for HIV?
Anyone that is sexually active
When should we screen for Nisseria. M, or chlamydia?
Any sexually active female <25
If a patient has recurrent UTI’s that aren’t treated with ceftriaxone consider ______ as a possible culprit of infection?
trichamonis
True/False; A patient that is found to have a nisserial urethritis should be treated with both azithromycin and Ceftraxone
true
How should we treat the partner of a patient that has Nisseria Ghonerrea
Oral cefixime + azithromycin
What is the triad for dissmenated gonoccal infection
Arthralgias, rash, an fever
A patient with painful vesicles on the labia presents to your office what is the next step in managment.
This is a clinical diagnosis, there is no need to get a tzanck smear unless you are unsure of the diagnosis.
What are conditions where a rash is present on the palms and soles?
Cocksackie, Rocky mountain spotted fever, Kawasaki, syphillis
What is the most common cause of septic arthritis in sexually active young adults?
Niss. G
What is the most common cause of septic arthritis in the general population?
Staph. A
What are the two types of angioedema
There is a bradykinin and histamine
What is the difference between angioedema and utacaria?
Uticaria is a superficial involvement of histamine release where as angioedema is in the dermis due to vascular permeability
_____ accumulation is responsible for the action we see in angioedema?
bradykinin
______ release is responsible for utacaria?
histamine
Angioedema caused by ace inhibitors is mediated by?
histamine
Patient presents to the ED after 6hrs of ingesting a sulfa drug with rupture bullae, mucosal ulcers. Nikosky’s sign is positive what is the dx?
SJS/TEN depending on the surface area coverage
A 16 yo girl presents to the ED hemodynamically unstable, and desquamation of the hands and feet. Nikolsky’s test is negative . Oral examination shows no mucosal involvement. What is the diagnosis?
TSS , look for risk factors like tampon and nasal packaging
This skin infection also occurs due to Staph. Patient may present with diffuse bullae. Nikolsky is positive. However this patient isn’t in any hemodynamic distress and there are no oral ulcers.
Scalded skin syndrome
Type IV HSR, causes a morbiliform rash + eosinophilia
DRESS syndrome (drug reaction with eosionphilia)
How can we differentiate a morbilliform rash that is due to DRESS v. serum sickness?
Typically serum sickness will have arthralgia where DRESS has some kind of end organ damage
What are the catalase positive organisms?
E.coli, Serratia, Pseudomonas, Nocardia, Listeria, Aspergillus, Candida, and Klebsiella, Staph. Areus
If a patient is suffering from recurrent infections with catalase + organisms what is the underlying issue?
Neutrophils: Neutropenia, leukocyte adhesion deficiency, CGD, Chediak-Higashi
What are the common signs/symptoms of Wiskott A
TEAM: thrombocytopenia, eczema, autoimmune condition , and malignancy
A patient who is in college has an insidious onset of headaches since this morning. The patient has become obtunded and has nuchal rigidity on passive neck flexion. The patients roommate noticed rash appearing on her earlier this morning. What bug do you think is causing the patients symptoms?
Nisseria Meningits; keep in mind that there are other bugs that can cause meningitis don’t have an acute course of presentation
What is organism that cause lyme disease?
Boriella B
What are the stages of lyme disease
What is the first line treatment for lyme disease?
Doxycycline, and for pregnant woman amoxicillin
A patient presents after a weekend at Yosemite national park with acute presentation of fatigue, muscle pain, fever. The. patient has red rash around the ankles. Labs show thrombocytopenia, and elevated AST and ALT what is the diagnosis.
Rickettsia R. In general RR progresses faster than lyme disease.
What is the treatment for RR
doxycycline
Describe the presentation of bordatella pertusis in one sentence.
Patient with mild cough that progresses to severe bought of coughing, waining immunity and not being vaccinated are risk factors
During application of local anesthetic to a patient a colleague gets stuck with a needle from a patient known to have HIV. Blood is drawn for testing what should the patient do in the meantime?
The patient should start PEP (post -exposure prophylaxis) which is three anti-retrovirals for 4 weeks.
A patient presents to the office with complaints of cracked and peeling skin in between the toes the patient is constantly on his feet and wears sneakers throughout the day, what may be the cause of the cracking and peeling.
Dermatophytes like trichophyton ruburum. They can cause an opening point for other bacteria to enter into the feet.
To prevent a patient from acquiring toxoplasmosis when should we give prophylactic treatment
<100 /mm3
What is the CD4 count number we need to prophylax for histoplasma?
< 150
When is prophylaxis indicated for CMV?
Only in patients with recent transplants.
How is Nisseria M spread
droplets, respiratory
What labs would help differentiate a bacterial versus a viral infection in the brain?
What vaccinations are adults with HIV able to get?
Hep A, Hep B, HPV, influenza (nasal is live and contranidicated), Nisseria Meningicocus (booster every 5 years), Tdap, strep. pneumo, Varicella can only be given if the CD count is greater than 500 otherwise a recombinant vaccine is required.
Lymphogranuloma venerum is the same as..
Chlamydia trachomatis
Group A contains what strep ?
Strep pyogenes: remember group A&B are under beta hemolytic strep
The primary bug that causes Erysipelas?
Strep pyogenes
What is the main organism that causes cellulitis?
If the cellulitis is purulent staph areus, if non- purulent than Strep. pyogenes
Strep pneumonia is the primary bacterial culprit in what pathologies?
MOPS, Meningitis, otitis media, pneumonia, and sinusitis
Strep Pyogenes is the primary bacterial culprit in what diseases?
LINES, lymphangitis, impetigo necrotizing fascitis, erysipelas (celluitus), Scarlett fever
How do you diagnose Hep C?
Serology Hep C IgG antibody
HCV RNA via molecular test
A patient recently returning from Ecuador has RUQ. On physical exam she has hepatomegaly. Labs show elevated eosinophils and imaging shows cysts. What is the treatment for this patient?
Albendazole; this patient has Echinococus granulosus which is a dog tapeworm that usually reside in it’s host sheep.
What is the most common cause for viral gastroenteritis?
Norovirus, unless they are younger than the age of two and have not been vaccinated.
