Infectious Disease Flashcards
How soon after potential tick exposure is RMSF still considered on the differential?
Around 3 weeks. If they were in the region much more than 3 weeks ago, its not very likely
What area is babesiosis endemic to?
Massachusettes
What is factitious fever?
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.
What patients (ethnicity and age) get familial mediterranean fever?
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
What are symptoms of familial mediterranean fever?
Fever lasting 1-3 days, abdominal pain, pleuritis, synovitis (joints). Often see leukocytosis and high ESR too.
Which drugs most commonly cause neuroleptic malignant syndrome?
Haloperidol + Fluphenazine
Which drugs most commonly cause malignant hyperthermia?
Halothane, isoflurane, desflurane, sevoflurane, succinylcholine, decamethonium
When would a Parkinson patient get malignant hyperthermia?
If abruptly discontinue levodopa or anticholinergics (because then their dopamine drops quickly, so its as if they got a dopamine antagonist)
Which findings are unique to serotonin syndrome?
Hyperreflexia, myoclonus, ataxia (the other stuff - fever, muscle rigidity, cognitive changes- are the same for NMS and MH)
What is the first step in managing sepsis?
Source control… so remove catheter, drain abscess, surgically debride wound
What are the indications for vasopressors to treat sepsis?
MAP (2*DP + SP)/3 stays below 65 mmhg even AFTER fluid resuscitation (like 4-6 liters)
Under what conditions does fluid resuscitation have a benefit on survival in patients with sepsis?
If it resolves lactic acidosis within 6 hours. This usually means 6 L in 6 hours.
When do you use activated protein C (drotrecogin alfa activated) as treatment?
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)
What are relative contraindications to treating sepsis with activated protein C (Drotrecogin alfa activated)?
Platelet count below 30,000 (It’s an anticoagulant)
What vasopressors can be used to treat sepsis?
- Norepinephrine (most commonly used. Reverses endotoxin-induced vasodilation which is the hallmark of septic shock)
- Dopamine (second line. More risk of arrhythmia and tachycardia)
When would you use hydrocortisone to treat septic shock?
If systolic blood pressure (not MAP) remains below 90 mmhg even after aggressive fluids AND vasopressors
What are diagnostic criteria for sepsis?
- Proven infection (either with culture, OR visually obvious like pus draining from a wound)
- At least two SIRS criteria (fever, tachycardia, tachypnea, leukocytosis with immature bands)
What is criteria for severe sepsis?
Organ dysfunction, hypotension, or lactic acidosis
What is the definition of SIRS (systemic inflammatory response syndrome)?
At least two:
- Temp higher than 38 deg C (100.4 F) or lower than 36 deg C (96.8 F)
- HR above 90
- RR above 20
- pCO2 below 32 mmhg
- leukocytosis above 12,000 or below 4,000 or more than 10% bands
What is criteria for septic shock?
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
What are complications fo group A strep infection?
Peritonsillar abscess
Glomerulonephritis
Rheumatic fever
What are symptoms of peritonsillar abscess?
- worsening sore throat despite antibiotics
- fever
- dysphagia
- pooling saliva
- +/- droolig and muffled voice
- enlarged tonsils
- deviation of uvula to unaffected side
How do you treat peritonsillar abscess?
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
What do you use to treat otitis media?
First line: Amoxicillin
If that doesnt work:
Augmentin, ceftriaxone, cefuroxime
If allergic to penicillins:
Azithromycin
What bacteria cause otitis media in adults?
Staph aureus, H. Flu, moraxella, strep pneumo
What is the 4 point scale for strep testing (centor score)?
\+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
When should you give antibiotics for sinusitis?
- Symptoms>7 days (now I think its 10 days)
- Purulent nasal discharge
- Facial pain
Which antibiotics would you use for sinusitis lasting >7 days with facial pain and purulent discharge?
Amoxicillin or doxycycline
How do you treat asymptomatic bacturia in pregnant women?
Ampicillin, amoxicillin, or nitrofurantoin
Then do a urine culture to confirm eradication
What is a transrectal ultrasound (or abdominal-pelvic CT) indicated for prostatitis?
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
What is the preferred antibiotic for treating prostatitis?
cipro or another fluoroquinolone because htey penetrate the prostate well and are safe
Which antibiotics should be avoided in patients with CKD?
aminoglycoside (ex: gentamicin)
If you need to drain the bladder of someone with prostatitis, how should you do it?
Suprapubic route, not transurethral. This is to reduce risk of abscess and septiciemia.
How do you treat asymptomatic bacteruria in a NON-pregnant person?
No treatment! Even if have diabetes
What is the definition of asymptomatic bacteruria?
2 voided urine specimens showing at least 10^5 unites of the same bacterial strain
What are indications to screen for bacteruira?
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.
How do you treat pyelonephritis?
Cipro for 1-2 weeks. IV if acutely ill or vomiting, oral if less ill and can take it
If pregnant: Cephalosporins, penicillins
How do you treat recurrent cystitis?
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
Symptoms of disseminated gonococcus?
- Fever
- rash (sparse necrotic pustules)
- joint pain and swelling in the knees, wrists, or hips
How do you treat gonorrhoeae? How do you treat chlamydia?
Gonorrhoeae: Ceftriaxone
Chlamydia: Doxycycline or azithromycin
How do you treat PCP? (symptoms of dyspnea, cough, fever in an AIDS patient)
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
What are prophylactic therapies for diseases in patients with AIDS?
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
Symptoms of acute HIV infection
sore throat, headache, fever, anorexia, muscle aches, rash on trunk and abdomen
How to test for acute HIV infection
HIV RNA viral loads + antibody
How do you prevent spread of menignitis?
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
Treat latent TB
Isoniazid + B6
Treat active TB (seen on CXR)
4 drug therapy
