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Outpatient Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

How soon after potential tick exposure is RMSF still considered on the differential?

A

Around 3 weeks. If they were in the region much more than 3 weeks ago, its not very likely

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2
Q

What area is babesiosis endemic to?

A

Massachusettes

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3
Q

What is factitious fever?

A

Usually in young women. Unusual fever patterns (very high brief spikes without chills or sweating). Patient feels poorly (dyspnea, abdominal pain) but vitals and PE are normal.

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4
Q

What patients (ethnicity and age) get familial mediterranean fever?

A

It’s an AR genetic disorder seen in jewish, turkish, arabic, armenian people. 95% of the time onset younger than 20 yrs, and usually younger than 10 yrs

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5
Q

What are symptoms of familial mediterranean fever?

A

Fever lasting 1-3 days, abdominal pain, pleuritis, synovitis (joints). Often see leukocytosis and high ESR too.

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6
Q

Which drugs most commonly cause neuroleptic malignant syndrome?

A

Haloperidol + Fluphenazine

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7
Q

Which drugs most commonly cause malignant hyperthermia?

A

Halothane, isoflurane, desflurane, sevoflurane, succinylcholine, decamethonium

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8
Q

When would a Parkinson patient get malignant hyperthermia?

A

If abruptly discontinue levodopa or anticholinergics (because then their dopamine drops quickly, so its as if they got a dopamine antagonist)

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9
Q

Which findings are unique to serotonin syndrome?

A

Hyperreflexia, myoclonus, ataxia (the other stuff - fever, muscle rigidity, cognitive changes- are the same for NMS and MH)

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10
Q

What is the first step in managing sepsis?

A

Source control… so remove catheter, drain abscess, surgically debride wound

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11
Q

What are the indications for vasopressors to treat sepsis?

A

MAP (2*DP + SP)/3 stays below 65 mmhg even AFTER fluid resuscitation (like 4-6 liters)

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12
Q

Under what conditions does fluid resuscitation have a benefit on survival in patients with sepsis?

A

If it resolves lactic acidosis within 6 hours. This usually means 6 L in 6 hours.

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13
Q

When do you use activated protein C (drotrecogin alfa activated) as treatment?

A

Severe sepsis (APACHE score above 25)…

  • gave fluids and MAP stayed below 65, so you had to give vasopressors
  • ARDS requiring mechanical ventilation
  • two or more organ dysfunctions (just one doesnt count)
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14
Q

What are relative contraindications to treating sepsis with activated protein C (Drotrecogin alfa activated)?

A

Platelet count below 30,000 (It’s an anticoagulant)

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15
Q

What vasopressors can be used to treat sepsis?

A
  1. Norepinephrine (most commonly used. Reverses endotoxin-induced vasodilation which is the hallmark of septic shock)
  2. Dopamine (second line. More risk of arrhythmia and tachycardia)
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16
Q

When would you use hydrocortisone to treat septic shock?

A

If systolic blood pressure (not MAP) remains below 90 mmhg even after aggressive fluids AND vasopressors

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17
Q

What are diagnostic criteria for sepsis?

A
  1. Proven infection (either with culture, OR visually obvious like pus draining from a wound)
  2. At least two SIRS criteria (fever, tachycardia, tachypnea, leukocytosis with immature bands)
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18
Q

What is criteria for severe sepsis?

A

Organ dysfunction, hypotension, or lactic acidosis

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19
Q

What is the definition of SIRS (systemic inflammatory response syndrome)?

A

At least two:

  1. Temp higher than 38 deg C (100.4 F) or lower than 36 deg C (96.8 F)
  2. HR above 90
  3. RR above 20
  4. pCO2 below 32 mmhg
  5. leukocytosis above 12,000 or below 4,000 or more than 10% bands
20
Q

What is criteria for septic shock?

A

It’s a subset of severe sepsis (organ dysfunction, hypotension, lactic acidosis) where the patients have HYPOTENSION DESPITE FLUIDS, PLUS perfusion problems.

If on pressors and not hypotensive, look for organ dysfunction

21
Q

What are complications fo group A strep infection?

A

Peritonsillar abscess
Glomerulonephritis
Rheumatic fever

22
Q

What are symptoms of peritonsillar abscess?

A
  • worsening sore throat despite antibiotics
  • fever
  • dysphagia
  • pooling saliva
  • +/- droolig and muffled voice
  • enlarged tonsils
  • deviation of uvula to unaffected side
23
Q

How do you treat peritonsillar abscess?

A

Refer to ENT emergently for drainage. This prevents from airway obstruction, dissection of parapharyngeal space, and spontaneous drainage leading to aspiration of pus while sleeping, and sepsis

24
Q

What do you use to treat otitis media?

A

First line: Amoxicillin

If that doesnt work:
Augmentin, ceftriaxone, cefuroxime

If allergic to penicillins:
Azithromycin

25
Q

What bacteria cause otitis media in adults?

A

Staph aureus, H. Flu, moraxella, strep pneumo

26
Q

What is the 4 point scale for strep testing (centor score)?

A 
\+1 for age 3-14 yrs old
\+1 FEVER (temp above 100.4 F or 38 C)
\+1 for TONSILS (exudate or swollen)
\+1 for LYMPHADENOPATHY (anterior cervical)
\+1 for ABSENT COUGH

0, 1: No testing, no antibiotics
2, 3: Do a rapid antigen test first. If negative, do a culture (more expensive).
4,5: Give antibiotics

27
Q

When should you give antibiotics for sinusitis?

A
  • Symptoms>7 days (now I think its 10 days)
  • Purulent nasal discharge
  • Facial pain
28
Q

Which antibiotics would you use for sinusitis lasting >7 days with facial pain and purulent discharge?

A

Amoxicillin or doxycycline

29
Q

How do you treat asymptomatic bacturia in pregnant women?

A

Ampicillin, amoxicillin, or nitrofurantoin

Then do a urine culture to confirm eradication

30
Q

What is a transrectal ultrasound (or abdominal-pelvic CT) indicated for prostatitis?

A

Failure to improve after 3 days of ciprofloxacin. Because this suggests he has a prostatic abscess.

Ultrasound is better than CT for patients with CKD

31
Q

What is the preferred antibiotic for treating prostatitis?

A

cipro or another fluoroquinolone because htey penetrate the prostate well and are safe

32
Q

Which antibiotics should be avoided in patients with CKD?

A

aminoglycoside (ex: gentamicin)

33
Q

If you need to drain the bladder of someone with prostatitis, how should you do it?

A

Suprapubic route, not transurethral. This is to reduce risk of abscess and septiciemia.

34
Q

How do you treat asymptomatic bacteruria in a NON-pregnant person?

A

No treatment! Even if have diabetes

35
Q

What is the definition of asymptomatic bacteruria?

A

2 voided urine specimens showing at least 10^5 unites of the same bacterial strain

36
Q

What are indications to screen for bacteruira?

A

NOT cystoscopy, UNLESS they are taking a biopsy

NOT catheter placement, UNLESS tissue trauma resulted in bleeding

Only pregnant women and before TRUP in men. Or biopsy.

37
Q

How do you treat pyelonephritis?

A

Cipro for 1-2 weeks. IV if acutely ill or vomiting, oral if less ill and can take it

If pregnant: Cephalosporins, penicillins

38
Q

How do you treat recurrent cystitis?

A

patient-initiated TMP SMX for 3 days when symptoms develop

If pyelonephritis, then need to do cipro for 1-2 weeks… not necessarily self-given

39
Q

Symptoms of disseminated gonococcus?

A
  • Fever
  • rash (sparse necrotic pustules)
  • joint pain and swelling in the knees, wrists, or hips
40
Q

How do you treat gonorrhoeae? How do you treat chlamydia?

A

Gonorrhoeae: Ceftriaxone
Chlamydia: Doxycycline or azithromycin

41
Q

How do you treat PCP? (symptoms of dyspnea, cough, fever in an AIDS patient)

A

TMP-SMX for three weeks + Ssteroids if the patient has O2 below 70 mmhg or AA gradient above 35 mmhg

Dapsone can be an adjuvant

42
Q

What are prophylactic therapies for diseases in patients with AIDS?

A

PCP: TMP SMX, CD4 below 200
Toxo: TMP SMX, CD4 below 100
MAC: Azithromycin, CD4 less than 50
TB: Ioniazid only if positive TB skin test above 5 mm

43
Q

Symptoms of acute HIV infection

A

sore throat, headache, fever, anorexia, muscle aches, rash on trunk and abdomen

44
Q

How to test for acute HIV infection

A

HIV RNA viral loads + antibody

45
Q

How do you prevent spread of menignitis?

A

Face mask if within 6-10 feet of the patient (nasopharynx is the reservoir for meningococal meningitis) also if meningococcal, family members should get prophylaxis

46
Q

Treat latent TB

A

Isoniazid + B6

47
Q

Treat active TB (seen on CXR)

A

4 drug therapy

Outpatient Medicine (16 decks)

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