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Step Two > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Common causes of PNA in Neonates

A

GBS
E. coli
Listeria

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2
Q

Common causes of PNA in Children (6w-18y)

A 
Viruses
S. pneumoniae
Mycoplasma
Chlamydia pneumoniae
S. aureus
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3
Q

Common causes of PNA in Adults (18-40)

A

Mycoplasma
S. pneumoniae
Viruses
C. pneumoniae

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4
Q

Common causes of PNA in Adults (40-65)

A 
S. pneumoniae
H. flu
Mycoplasma
Viruses
Anaerobes
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5
Q

Common causes of PNA in Elderly (65+)

A 
S. pneumoniae
H. flu
Viruses
S. aureus
GNRs
Anaerobes
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6
Q

Causes of PNA: Atypical

A

Mycoplasma
Legionella
Chlamydophila (chlamydia)

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7
Q

Causes of PNA: Nosocomial

A

GNRs
Staph (MRSA)
Anaerobes
Pseudomonas (intubated pts)

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8
Q

Causes of PNA: Immunocompromised

A 
Staph
Gram + rods
Fungi
virus
PCP
Mycobacteria
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9
Q

Causes of PNA: Aspiration

A

Anaerobes

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10
Q

Causes of PNA: Alcoholics/IV drugs

A

S. pneumo
Klebsiella
Staph

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11
Q

Causes of PNA: Cystic Fibrosis

A

Staph (under 20)
Pseudomonas (over 20)
Burkholderia
mycobacteria

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12
Q

Causes of PNA: COPD

A

H flu
Moraxella catarrhalis
S pneumo

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13
Q

Causes of PNA: Post-viral

A

Staph
S pneumo
H flu

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14
Q

Causes of PNA: Neonates

A

GBS
E. coli
Listeria

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15
Q

Causes of PNA: Recurrent

A

Obstruction, bronchogenic carcinoma, lymphoma, Wegener’s, immunodef., unusual organisms (nocardia, coxiella, aspergillus, pseudomonas)

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16
Q

Treatment of PNA: CAP

A

Macrolide (Azithromycin, Erythromycin) or Doxycycline

[S. pneumo, mycoplasma, chlamydia, h flu, viral]

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17
Q

Treatment of PNA: with comorbid disease

COPD, HF, CKD, DM, Liver
>65, or recent ABx (in 3 mo)

A

Fluoroquinolone (levofloxacin, moxyflocacin)
or Betalactam + macrolide (Ceft/Azith)

[S pneumo, H flu, E. coli, enterobacter, klebs, s aureus, legionella, virus]

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18
Q

Treatment of PNA: CAP req hospitalization

CURB-65

A

Fluoroquinolone (levo)
or antipneumococcal betalactam + macrolide (Ceft/Azith)

[S pneumo, h flu, anaerobes, E. coli, klebs, legionella, chlamydia]

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19
Q

Treatment of PNA: CAP req ICU

A

Antipneumococcal beta-lactam

+ either azythromycin or fluoroquinolone

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20
Q

Treatment of PNA: HCAP

A

cefepime or imepenem/meropenem
+ gentamycin or levofloxacin

Extended spec Cephalosporin
or carbapeneme with antipseudomonal
-Add aminoglycoside or fluoroquinolone for resistant organisms

[GNRs (pseudomonas, acinetobacter), s aureus, legionella, mixed]

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21
Q

Treatment of PNA: critically ill

A

Add vancomycin or linezolid, broaden gram neg coverage

[MRSA]

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22
Q

Rx for TB: agents

A

RIPE for treatment

Rifampin {orange body fluids}
INH {peripheral neuropathy, hepatitis}
Pyrazinamide
Ethambutol {optic neuritits}

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23
Q

Rx for TB: duration

A

Active: 4 drug x2 mo; then INH + rifampin x4 mo
–Give Vitamin B6, pyridoxine, to prevent INH peripheral neuropathy

Latent: INH x 9 mo (or 6 mo, or rifampin x4 mo)

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24
Q

Causes of acute sinusitis

A

++viruses
strep pneumoniae
H flu
m catarrhalis

bacterial = rare, has purulent nasal discharge, symptoms > 10 days

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25
Q

Complications of sinusitis

A 
Meningitis
Frontal bone osteomyelitis
Cavernous sinus thrombosis
abscess
Orbital cellulitis (post-septal)
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26
Q

Rx for sinusitis

A

Acute: amox/clav x10 days (or azith, bactrim, 2nd gen ceph)

Chronic: same Abx for LONGER: 3-6 wks

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27
Q

Pt from Nevada, Arizona, New Mexico, California, Texas (mexico) with respiratory complaints?

also Rx?

A

Coccidioidomycosis

Rx: PO fluconazole or itraconazole
IV amphotericin B if severe

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28
Q

HIV+, pregnant, filipino, black from SW state?

A

Increased risk for disseminated Coccidioidomycosis

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29
Q

fever, myalgias, chills, cough, coryza, but rapid flu negative?

A

Still think flu, rapid flu test has low sensitivity

PCR assays, DFA and viral culture more definitive

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30
Q

Rx for influenza

A

symptomatic

oseltamivir or zanamivir IF WITHIN 2 DAYS OF ONSET can reduce duration of illness by 1-3 days

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31
Q

Causes of Meningitis by Age: Newborn

A

GBS
E. coli/ GNRs
Listeria

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32
Q

Causes of Meningitis by Age: Children (6mo-6y)

A

S. pneumo
N. meningitidis
H flu type b
Enterovirus

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33
Q

Causes of Meningitis by Age: 6y-60y

A

N. meningitidis (#1 in teens)
S pneumoniae
Enteroviruses
HSV

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34
Q

Causes of Meningitis by Age: >60

A

S pneumoniae
GNRs
Listeria
N meningitidis

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35
Q

Empiric Rx for Meningitis by Age: Neonate

A

Ampicillin
+ cefotaxime
or gentamicin

[GBS, E coli, Listeria]

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36
Q

Empiric Rx for Meningitis by Age: 1mo-3mo

A

Vancomycin IV
+ Ceftriaxone
or Cefotaxime

[pneumococci, meningococci, h flu]

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37
Q

Empiric Rx for Meningitis by Age: 3mo - adult

A

Vancomycin IV
+ Ceftriaxone
or Cefotaxime

[pneumococci, meningococci]

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38
Q

Empiric Rx for Meningitis by Age: >60, ETOH, Chronic Illness

A

Ampicillin
+ vancomycin
+ cefotaxime
or ceftriaxone

[pneumococci, gram neg bacilli, listeria, meningococci]

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39
Q

Rx for contacts of meningococcal meningitis

A

RIFAMPIN, CIPROFLOXACIN or ceftriaxone

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40
Q

Dexamethasone in meningitis?

A

Reduce neurologic complications of S PNEUMO meningitis if given 15-20 MIN BEFORE ABX

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41
Q

Complications of meningitis

A 
SENSORINEURAL HEARING LOSS
mental impairment
seizures
increased ICP
empyema
abscess
focal neuro deficits, coma, death
hyponatremia
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42
Q

RBC in CSF, no history of trauma?

A

highly suggestive of HSV encephalitis

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43
Q

CNS Infection key words:

Photophobia, nuchal rigidity

A

meningitis

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44
Q

CNS infection key words:

Focal neurologic deficits

A

brain abscess

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45
Q

CNS infection key words:

Confusion, mental status changes

A

Encephalitis

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46
Q

HSV Encephalitis:

Dx & Rx?

A

PCR highly sensative and specific
CT or MRI shows TEMPORAL LOBE SIGNAL
Rx with IV Acyclovir asap

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47
Q

CMV encephalitis Rx?

A

IV Ganciclovir +/- foscarnet

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48
Q

Brain abscess imaging?

A

Ring-enhancing lesion

If hematogenous spread, multiple abscess at Grey-white junciton in middle cerebral distribution

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49
Q

Fever, confusion, dull constant headache, no relief with nsaids, papilledema, CN III and CN VI palsy?

A

indicative of brain abscess

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50
Q

Fever, headache, focal neurological deficit?

A

Triad for Brain Abscess

present in 50% of cases

51
Q

Rx for brain abscess?

A

IV Abx and surgical drainage (no surgery if less than 2 cm)

52
Q

CD4 ~ 500

also ppx?

A 
Herpes Simplex
Herpes Zoster
Vaginal candidiasis
Hairy leukoplakia
Kaposi Sarcoma
TB and bact. infections

Bactrim (50?)

53
Q

CD4 less than 200

also ppx?

A 
PCP
Toxo
Cryptococcosis
Coccidioidomycosis
Cryptosporidiosis

Bactrim double strength (100?)

54
Q

CD4 less than 50

also ppx?

A

Disseminated MAC
Histoplasmosis
CMV retinitis
CNS lymphoma

Azithromycin

55
Q

Side effects: Protease Inhibitors

A

hyperglycemia
hyperlipidemia
lipodystrophy

56
Q

Side effects: Thiazides

A 
Hyperglycemia
Hypertriglyceridemia
Hypercalcemia
Hyponatremia
Hypokalemia
Hypomagnesemia
57
Q

Side effects: Nucleoside RTIs

A

Bone marrow suppression
neuropathy
lactic acidosis?

58
Q

Side effects: Indinavir

A

crystal-induced nephropathy

nephrolithiasis

59
Q

Side effects: Didanosine

A

pancreatitis

60
Q

Side effects: Abacavir

A

hypersensitivity

61
Q

Side effects: Nevirapine

A

liver failure

62
Q

Side effects: Efavirenz

A

vivid dreams, hallucinations

63
Q

Pizza pie retinopathy, floaters and visual field changes, association with retinal detachment

A

CMV retinitis

CD4 less than 50

64
Q

Bloody diarrhea, abdominal pain, CD4 less than 50

A

CMV colitis

65
Q

Systems CMV manifests in AIDS?

A

Retinitis (retinal detachment)
GI & hepatobiliary (bloody diarrhea)
pneumonitiis (coufh, sparse sputum, high mortality)
CNS (polyradiculopathy, transverse myelitis, encephalitis)

66
Q

Rx for CMV infection?

A

Ganciclovir or valganciclovir +/- foscarnet

67
Q

Fever, weakness
elevated Alk Phos and LDH
HIV not on HAART
biopsy shows foamy macrophages with acid-fast bacilli

A

MAC, disseminated if CD4 less than 50

68
Q

multiple hypodense ring-enhancing mass lesions on CT/MRI

A

Toxoplasmosis encephalitis

Rx is high dose PO pyrimethamine + sulfadiazine and leucovorin (folic acid analog prevents heme toxicity) for 4-8 weeks

Bactrim as prophylaxis if CD4 less than 100

69
Q

Ring-enhancing lesions in AIDs

A

Toxoplasmosis
CNS lymphoma
(abscess?)

70
Q

Chlamydia Rx in pregnancy?

A

Azithromycin or Amoxicillin

71
Q

Chlamydia Rx

A

Doxycycline x7days or azithromycin

72
Q

Reiter Syndrome?

A

Complication of Chlamydia

urethritis, conjunctivitis, arthritis

73
Q

Fitz-Hugh-Curtis Syndrome?

A

complication of chlamydia

perihepatic inflammation and fibrosis

74
Q

Hemorrhagic, painful pustules on erythematous base
Monoarticular septic arthritis
Tenosynovitis

also Rx?

A

Disseminated gonorrhea

Ceftriaxone IM and Azithromycin PO

75
Q

Rx syphilis

A

Benzathine PCN IM

or Tetracycline/doxycycline x14 days in PCN allergy

76
Q

Rx syphilis in pregnancy

A

Benzathine PCN

If allergic, desensitize and rx with PCN

77
Q

Headache, fever, chills, myalgias, just started PCN for rash on palms and soles

A

Jarisch-Herxheimer reaction, from release of endotoxins from killed syphilis organisms (treponema pallidum)

78
Q

Common UTI bugs

A

SEEKS PP

Serratia
E COLI
Enterobacter
Klebsiella
Staph saprophyticus
Pseudomonas
Proteus mirabilis
79
Q

Beefy red genital ulcer with rolled edge of granulation tissue
Painless
Granulomatous ulcers

also Rx?

A

Klebsiella Granulomatis
aka
Granuloma inguinale

Rx Doxy/Azith

80
Q

Painful papule or pustule on genitals
irregular, deep, necrotic
1-2 cm
Inguinal lymphadenopathy

also Rx?

A

Haemophilus ducreyi (“do cry”)

Rx Azith or Ceftri

81
Q

Rx uncomplicated UTI

A

PO bactrim, fluoroquin x3 days or nitrofurantoin x5

82
Q

Rx complicated UTI

obstruction, men, renal txplant, catheters, instruments

A

PO bactrim, or fluoro or nitro x7-14 days

83
Q

Rx UTI in pregnancy

A

AMOXICILLIN 3-7 days
or nitrofurantoin or oral cephalsporin

treat asympto and sympto, to prevent pyelonephritis

84
Q

Rx pyelonephritis

A

Fluoroquinolones

if severe, admit, 3rd/4th gen cephs, carbapenems, beta/lactamase inhibs

85
Q

Rx pyelonephritis in pregnancy

A

Admit, 3rd gen cephalosporin

86
Q

SIRS criteria

A

Temp 38
RR >20
HR >90
WBCs 12000

87
Q

Deadliest form of malaria?

A

Plasmodium falciparum (falchion)
others
P vivax, P ovale, P malariae

88
Q

Dx of malaria?

A

Giemsa- or Wright-stained thick and thin blood films

or rapid antigen, fluorescent antibody, or PCR if available

89
Q

Rx for malaria?

A

Chloroquine PO
+ Primaquine for P vivax & P ovale or Unknown to eradicate hypnozoites in liver

If severe, IV Quinidine

90
Q

Malaria prophylaxis?

A

Atovaquone-proguanil and mefloquine

first line for chloroquine-resistant malaria

91
Q

Young adult, fever, fatigue, sore throat, posterior cervical lymph nodes, complains of facial droop, blurred vision, and numbness/weakness spreading up his legs

A

CNS infection, complication of EBV Infectious Mononucleosis

can be meningitis, encephalitis, CN palsies (VII), optic neuritis, transverse myelitis, or Guillain-Barre syndrome

92
Q

Young adult male, fever, fatigue, sore throat, posterior cervical lymph nodes, develops RUQ pain, jaundice, confusion, and abnormal LFTs

A

Fulminant hepatic necrosis, complicatino of EBV Infecitous mononucleosis

93
Q

Most common cause of Fever of Unknown Origin

A

Infection and cancer ~ 60%
Autoimmune disease ~15%

in elderly, rheumatic dz is 1/3 of cases

94
Q

Rx for Fever of Unknown Origin with negative work-up

A

Stop unnecessary medications
No empiric ABx indicated
Good prognosis, most resolve in months to years

95
Q

Rx for Neutropenic Fever

A

Empiric Antipseudomonal agent (cefepime, piperacilin-tazobactam)
If persists >72 hours, start antifungal Rx

96
Q

Headache, fever, chills, myalgias, confusion
travel to louisiana, camping
Leukopenia, thrombocytopenia
Elevated LFTs

A

Ehrlichiosis from lone star tick

Rx Doxycycline

Rash uncommon

97
Q

Headache, fever, malaise, macular rash on wrists and ankles that spreads to body as petechial/purpuric rash

A

Rocky Mountain Spotted Fever
rickettsia reckettsii
small vessel vasculitis
Rx Doxycycline or chloamphenicol for pregnancy

98
Q

Injected conjunctiva, eye pain, discharge, gram stain shows gram - intracellular diplococci

A

EMERGENCY! Neisseria gonorrhoeae infection
Corneal involvement can perforate and cause blindness
IM or IV Ceftriaxone, admit if complicated

99
Q

Copious watery eye discharge, severe ocular irritation, preauricular lymphadenopathy

A

Adenovirus

contagious, but self-limited

100
Q

Neonate with mucopurulent conjunctivitis

A

Chlamydia trachomatis

Rx Azithromycin, tetracycline, or erythromycin x3-4 weeks

101
Q

PE feature of Infective Endocarditis

A

FROM JANE

Fever
Roth Spots (retinal hemorrhage)
Osler nodes (tender nodules on finger/toe)
Murmur (mitral valve)
Janeway lesions (periph. hemorrhage)
Anemia
Nail hemorrhage (splinter)
Emboli (focal neuro deficit?)
102
Q

Causes of acute endocarditis

A

S aureus (IV drug, prosthetic valve)
S pneumoniae
N gonorrhoeae

103
Q

Causes of subacute endocarditis

A 
Viridans strep (native valve, dental procedures)
Enterococcus (UTIs)
S epidermidis (prosthetic valve)
S bovis (GI insult, malignancy)
Fungi
104
Q

Causes of marantic endocarditis

A

Cancer
Metasteses seed valves, emboli cause cerebral infarct

poor prognosis

105
Q

Causes of culture negative endocarditis

A 
HACEK
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

also coxiella, brucella, bartonella

106
Q

Endocarditis and SLE

A

Libman-sacks endocarditis

antibodies to the valve

107
Q

Rx endocarditis

A

IV vancomycin + gentamicin, then tailor

108
Q

hunter or rancher presents with pruritic papule, becomes ulcer, develops black eschar a week later

also Rx?

A

Cutaneous anthrax (bacillus anthracis, gram +)

Rx Ciprofloxacin or doxycycline plus 1-2 additional Abx for 14 days

109
Q

Sheep rancher with fever, hypoxia, hypotension, cough, SOB, CXR shows widened mediastinum and pleural effusions

also Rx?

A

Pulmonary anthrax causing hemorrhagic mediastinitis

Cipro/doxy plus 1-2 additional ABx for 14 days

110
Q

Osteomyelitis in otherwise healthy?

A

Staph aureus

111
Q

Osteomyelitis in IV drug user

A

S aureus or pseudomonas

112
Q

Osteomyelitis in Sickle Cell disease

A

Salmonella (no spleen, capsulated organism)

113
Q

Osteomyelitis in Hip replacement

A

S epidermitis

114
Q

Osteomyelitis in foot puncture wound

A

pseudomonas

115
Q

Chronic osteomyelitis

A

S aureus, psudomonas, enterobacteriaceae

116
Q

Osteomyelitis in diabetic

A

polymicrobial, pseudomonas, s aureus, strep, anaerobes

117
Q

Risk factors for osteomyelitis

A 
peripheral vascular disease
diabetes
penetrating injury
chronic decubitus ulcer
IV drugs (vertebral)
118
Q

Rx for diabetic with osteomyelitis

A

target g+ and anaerobes

vancomycin and clindamycin

119
Q

Rx Toxoplasmosis encephalitis

A

pyrimethamine
+ sulfadiazine
+ leucovorin

Rx is high dose PO pyrimethamine + sulfadiazine and leucovorin (folic acid analog prevents heme toxicity) for 4-8 weeks

120
Q

Most common cause of PNA in CF child (under 20)

A

Staph aureus

121
Q

Most common cause of PNA in CF adult (over 20)

A

Pseudomonas aeruginosa

122
Q

22 yo male, fever, sore throat, malaise
cervical and axillary lymphadenopathy
Hepatosplenomegaly
Jaundice

What am I? Complication?

A

Infectious Mononucleosis

Autoimmune hemolytic anemia (EBV ab’s cross react with RBCs and Platelets)

123
Q

Most common cause of sepsis in child with sickle cell?

A

Strep pneumo DESPITE VACCINATION (other serotypes)

hence PCN ppx

124
Q

Classic triad of congenital rubella

A

deafness, cataracts, cardiac defects (PDA, VSD)

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