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Infectious Disease Flashcards

1
Q

How do you diagnose Legionella?

A

Urine legionella antigen test

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2
Q

How do you diagnose chlamydophila pneumonia?

A

PCR

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3
Q

What type of pneumonia presents with serum cold agglutinins?

A

Mycoplasma

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4
Q

How do you diagnose pneumococcal pneumonia?

A

Urine pneumococcal antigen testing

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5
Q

What are the CURB-65 criteria for hospital admission for pneumonia?

A

-Confusion
-Uremia (BUN over 19)
-Respiratory rate over 30
BP lower than 90 / 60
-Age over 65

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6
Q

What are the top three causes of pneumonia in neonates?

A

GBS
E. Coli
Listeria

(GEL)

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7
Q

What is the most common cause of pneumonia in children? Young adults?
Elderly?

A

Children = viruses or strep

YA = Mycoplasma pneumonia

Elderly = S. pneumo

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8
Q

What are the three major bacteria that cause atypical pneumonia?

A

Mycoplasma
Legionella
Chlamydophila

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9
Q

What are the top three nosocomial causes of pneumonia?

A

GNRs
Staph anaerobes
Pseudomonas

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10
Q

What is the most common infectious agent(s) implicated in aspiration pneumonia?

A

Anaerobes

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11
Q

What is the treatment for outpatient pneumonia?

A

Macrolide or doxycycline

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12
Q

What is the treatment for inpatient pneumonia with multiple relevant comorbidities?

A

Fluoroquinolones

or beta-lactam+macrolide

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13
Q

What is the treatment for CAP requiring hospitalization?

A

Fluoroquinolone or antipseudomonal beta-lactam + macrolide

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14
Q

What is the treatment for CAP requiring ICU care?

A

Antipneumococcal beta lactam + (azithromycin or fluoroquinolone)

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15
Q

What is the treatment for hospital/institution acquired pneumonia?

A

Cephalosporin

Aminoglycoside or flouroquinolone

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16
Q

What is the treatment for MRSA pneumonia?

A

Vanco

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17
Q

What marks an active infection of TB?

A

Mycobacterial culture of sputum or blood

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18
Q

What is the TB drugs that turns urine, sweat, and tears orange?

A

Rifampin

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19
Q

What is the classic side effect of ethambutol?

A

optic neuritis

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20
Q

What are the classic side effects of INH? (2)

A

Peripheral neuropathy

Hepatitis

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21
Q

What qualifies as latent TB diagnosis?

A

+ PPD or GOLD, but negative sputum cultures

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22
Q

What is the treatment for active TB?

A

RIPE x 2 months

INH+rifampin x 4 months

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23
Q

What is the treatment for latent TB?

A

INH x 9 months

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24
Q

True or false: early treatment for strep pharyngitis can prevent both rheumatic fever and glomerulonephritis

A

False–not glomerulonephritis

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25
Q

What is the hemolytic pattern of GAS?

A

ALpha

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26
Q

What are the common viral causes of pharyngitis?

A

Rhinovirus

Coronavirus

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27
Q

What amount of induration indicates a positive PPD for: HIV, or close to TB

A

5 mm

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28
Q

What amount of induration indicates a positive PPD for: Indigent/homeless, residents of developing nations

A

10 mm

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29
Q

What amount of induration indicates a positive PPD for: healthcare workers

A

10 mm

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30
Q

What amount of induration indicates a positive PPD for: healthy with no known risk factors?

A

15 mm

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31
Q

What is the treatment for GAS pharyngitis?

A

Amoxicillin x 10 days

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32
Q

What are the two major nonsuppurative complications of strep pharyngitis?

A

Rheumatic fever

glomerulonephritis

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33
Q

What are the two major suppurative complications of strep pharyngitis?

A

Cervical LAD
Mastoiditis
Simusitis
OM

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34
Q

What is the difference in timeframe for acute vs chronic sinusitis?

A
  • Acute = less than 1 month

- Chronic = more than 3 months

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35
Q

What two infectious agents are diabetic and immunosuppressed patient particularly susceptible to in terms of sinusitis?

A

Mucor

Rhizopus

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36
Q

Where is coccidioidomycosis found geographically?

A

Southwest US

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37
Q

What is the treatment for acute coccidioidomycosis?

A
  • azole for mild

- IV amp B for disseminated

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38
Q

What is antigenic drift?

A

Small, gradual changes in surface proteins through point mutations, which are the cause of seasonal variance

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39
Q

What is antigenic shift?

A

Acute, major change in the influenza A subtype leading to pandemics

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40
Q

What are the histologic findings of coccidioidomycosis?

A

Spherules

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41
Q

At what age can kids get their first flu vaccine?

A

6 months for injectable

2 years for LAV

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42
Q

What are the top three most common causes of meningitis in newborns?

A
  1. GBS
  2. E.coli
  3. Listeria
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43
Q

What are the top three most common causes of meningitis in children (6 months - 6 years)?

A
  1. Strep pneumo
  2. N, meningitidis
  3. H. flu
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44
Q

What are the top three most common causes of meningitis in 6-60 year olds?

A
  1. N meningitidis
  2. Strep pneumo
  3. Enterovirus
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45
Q

What are the top three most common causes of meningitis in 60+?

A
  1. Strep pneumo
  2. GNRs
  3. Listeria
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46
Q

What are the classic CSF findings of multiple sclerosis?

A

Increased gamma globulins

monoclonal bands

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47
Q

What is the prophylaxis for people in close contact to a pt who has contracted meningococcal meningitis?

A

Rifampin or cipro

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48
Q

What are the 2 abx of choice to treat neonatal meningitis?

A

Ampicillin + gentamicin (cefotaxime)

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49
Q

What are the 2 abx for treating 1-3 mo with meningitis?

A

Vanco + Ceftriaxone (cefotaxime)

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50
Q

What are the 2 abx for treating meningitis in 3 mo to adulthood?

A

Vanco + ceftriaxone (cefotaxime)

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51
Q

What are the three abx for treating meningitis in a 60 yo +?

A

Ampicillin + vanco + ceftriaxone (cefotaxime)

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52
Q

RBCs in a LP without a h/o trauma strongly suggests what cause of meningitis?

A

HSV

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53
Q

With what cause of meningitis is dexamethasone given?

A

Strep pneumo

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54
Q

What are the two most common causes of encephalitis?

A

HSV and arboviruses

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55
Q

What are the usual s/sx of encephalitis? (4)

A
  • AMS
  • HA
  • Fever
  • Seizures
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56
Q

What are the five causes of encephalitis that are diagnosed with PCR of CSF?

A 
VZV
HSV
EBV
CMV
Enteroviruses
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57
Q

What infectious process can cause focal neurologic symptoms?

A

Brain abscess

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58
Q

What is the treatment for HSV and CMV encephalitis respectively?

A 
HSV = acyclovir
CMV = ganciclovir
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59
Q

What is the treatment for RMSF encephalitis? Lyme disease?

A 
RMSF = doxycycline
Lyme = ceftriaxone
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60
Q

What is the appearance of brain abscesses on imaging?

A

Ring enhancing lesions (d/t fibrotic capsule)

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61
Q

What are the common infectious etiologies of brain abscesses?

A

Strep
Staph
Anaerobes

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62
Q

What is the bacteria that is usually implicated in brain abscesses that spread from the paranasal sinuses?

A

Strep milleri

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63
Q

If a brain abscess is the result of hematologic spread of bacteria, where in the brain are they usually found?

A

Middle cerebral artery distribution (usually multiple) at the Gray-white junction

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64
Q

What are the s/sx of brain abscesses?

A
  • Increased ICP
  • Focal neurologic deficits
  • HA
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65
Q

Which CNs are often affected by brain abscesses?

A

CN III and VI

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66
Q

Why is CSF analysis contraindicated in most cases of brain abscesses?

A

High ICP 2/2 abscess can cause herniation

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67
Q

What are the lab values that are often elevated with brain abscesses?

A

ESR and CRP

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68
Q

What is the treatment for brain abscesses?

A

IV abx and surgical drainage

-Dexamethasone or mannitol if increased ICP

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69
Q

What is the difference in the clinical value of CD4 counts and viral load for HIV pts?

A

CD4 = degree of immunosuppression

Viral load = rate of disease progression

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70
Q

What is the screening test for HIV? Confirmatory?

A 
Screening = ELISA
Confirmatory = western blot
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71
Q

What is the role of HIV RNA PCR?

A

Used for cases of acute HIV infection, since this time period may result with a negative western blot

72
Q

What is the general schema of HIV treatment?

A

2 NRTIs + (1 NNRTI or protease inhibitor or integrase inhibitor)

73
Q

What are the common side effects of protease inhibitors? (3) What is the common suffix?

A

-“navirs”
Hyperglycemia
Hyperlipidemia
Lipodystrophy

74
Q

What are the common side effects of NRITs? (2) What is the common suffix?

A
  • Bone marrow suppression

- neuropathy

75
Q

What are the common side effects of indinavir?

A
  • crystal induced nephropathy

- nephrolithiasis

76
Q

What are the common side effects of didanosine?

A

Pancreatitis

77
Q

What are the common side effects of abacavir?

A

hypersensitivity rxn

78
Q

What are the common side effects of nevirapine

A

Liver failure

79
Q

What are the common side effects of efavirenz?

A

Vivid dreams

Hallucinations

80
Q

What is the PEP for HIV?

A

source, begin ART as soon as possible with a basic two drug regimen or an expanded regimen of three or more drugs for 4 weeks, depending on the severity of the source infection.

81
Q

What are the only two live vaccines that can be given to HIV pts?

A

MMR and varicella

82
Q

What is the drug and CD4 count at which prophylaxis if given for: PCP?

A

200

TMP-SMX

83
Q

What is the drug and CD4 count at which prophylaxis if given for: MAC

A

50

Azithromycin

84
Q

What is the drug and CD4 count at which prophylaxis if given for: toxo?

A

100

Double strength TMP-SMX

85
Q

What is the drug and mm induration at which prophylaxis if given for: TB

A

5 mm or if high risk

INH x 9 months OR rifampin x 4 months

86
Q

What is the treatment for candida esophagitis and thrush in HIV pts?

A 
Esophagitis = fluconazole
Oral = above OR nystatin swish and swallow
87
Q

What is the drug and s/sx at which prophylaxis is given for HIV pts with: HSV

A

Multiple recurrences

Daily acyclovir

88
Q

What are the 8 major pathogens that signify significant T cell collapse in HIV pts?

A
  • Toxo
  • MAC
  • PCP
  • Candida
  • Cryptococcus
  • TB
  • CMV
  • Cryptosporidium
89
Q

What is the classic exposure that causes cryptococcal meningitis?

A

Exposure to pigeon droppings

90
Q

How is cryptococcal meningitis different from other etiologies of meningitis in terms of presentation?

A

Usually no meningeal signs

91
Q

What is the diagnostic test for cryptococcal meningitis?

A

Antigen testing of CSF

92
Q

What is the treatment for cryptococcal meningitis?

A

Amp B + fluconazole x 2 weeks, then fluconazole

93
Q

What is the classic exposure for histoplasmosis? Where?

A

Bird or bart excrement in ohio and mississippi river valleys

94
Q

What are the severe s/sx of histoplasmosis?

A

fever
weight loss
HSM

95
Q

What are the CXR findings of histoplasmosis?

A

diffuse nodular densities

96
Q

What is the diagnostic test of choice for histoplasmosis?

A

Urine and serum polysaccharide antigen test

97
Q

What is the treatment for histoplasmosis causing the following:

  • Mild pulmonary disease
  • Chronic cavitary lesions
  • Severe acute pulmonary disease or disseminated disease
A
  • Mild pulmonary disease = supportive
  • Chronic cavitary lesions = itraconazole x 1 year
  • Severe acute pulmonary disease or disseminated disease = amp B
98
Q

What is the stain that classically used to diagnose PCP pneumonia?

A

Silver stain

99
Q

When should PCP pneumonia be treated with steroids?

A

If PaO2 less than 70, or A-a gradient over 35

100
Q

What are the visual symptoms associated with CMV retinitis?

A

Retinal detachment –floaters and visual field changes

101
Q

AIDS cholangiopathy is associated with which infectious agent?

102
Q

What are the symptoms of CMV pneumonitis, and in whom is it classically seen?

A
  • Non-productive cough

- More common in pts with malignancy

103
Q

What are the three major neurologic manifestations of CMV?

A

Polyradiculopathy
Transverse myelitis
Encephalitis

104
Q

What is the treatment for CMV infections?

A

ganciclovir or valganciclovir

105
Q

What is the classic presentations of disseminated MAC attack?

A

Weakness, fever,weight loss

AIDS pts not on HAART

106
Q

What are the lab findings of MAC?

A

increased serum alk phos

Increased LDH

107
Q

What is the treatment for MAC? 2nd line?

A
  1. Clarithromycin

2. ethambutol + rifabutin

108
Q

Toxo has a predilection for what part of the brain?

A

basal ganglia

109
Q

What is the treatment for toxo?

A

Pyrimethamine + sulfadiazine and leucovorin

110
Q

What are the two ddx that should be considered with ring enhancing lesions on MRI in the brain of an AIDS pt?

A

toxo vs CNS lymphoma

111
Q

What is the causative agent of lymphogranuloma venereum? S/sx?

A
  • Chlamydia
  • Painless transient papule/pustule, followed by painful swelling of inguinal lymph nodes AND/OR anal discharge, rectal strictures
112
Q

What is the diagnostic test for chlamydia?

A

URine test (nucleic acid test)

113
Q

What will gram stain show with chlamydia?

A

PMNs, but no bacteria

114
Q

What is the treatment for chlamydia?

A

Doxycycline PO x7 days or azithromycin IM x1

115
Q

What are the gram stain and morphologic findings of gonorrhea?

A

Gram negative intracellular diplococcus

116
Q

What is the classic d/c found with gonorrhea?

A

Greenish-yellow

117
Q

What is the diagnostic test of choice for gonorrhea?

A

MAAT but culture is gold standard

118
Q

What is the treatment for gonorrhea?

A

Ceftriaxone IM AND PO (regardless of whether chlamydia is present)

119
Q

True or false: Condoms prevent the spread of gonorrhea

120
Q

What defines the early latent stage of syphilis? late latent?

A 
early = from resolution of primary or secondary, to end of first year
Late = after 1 year
121
Q

What stage of syphilis are gummas seen?

122
Q 
What are the:
-Viruses
-autoimmune diseases
-drugs
That can cause a false positive VDRL test?
A
  • HIV/HSV/Hepatitis
  • IV drugs (and others)
  • Rheumatic fever/rheumatoid arthritis
  • SLE
123
Q

What is the treatment for primary, secondary, and tertiary syphilis?

A
  • Primary and secondary = benzathine PCN, IM
  • tertiary (latent) = above
  • Tertiary (neuro) = IV PCN
124
Q

What are the components of the SEEKS PP mnemonic for that infectious etiologies of UTIs?

A 
Serratia
E.coli
Enterobacter
Klebsiella
Staph saprophyticus
Pseudomonas
Proteus mirabilis
125
Q

What is the only group of patients that warrant treatment for asymptomatic UTIs?

A

Children and pregnant women

126
Q

What is the abx of choice for treating UTIs in pregnant women?

A

Nitrofurantoin (macrobid)

127
Q

What is the risk of untreated UTI in prego women?

128
Q

What is the first line abx for pyelo?

A

Fluoroquinolones

129
Q

What is the classic lesion of granuloma inguinale? Pain? What causes it? Treatment?

A
  • Beefy-red ulcer
  • painless
  • Klebsiella granulosum
  • doxy or azithromax
130
Q

What are the four components of SIRS criteria?

A
  • Temp not [36,38]
  • Tachypnea (over 20 or PaCO2 less than 32
  • Tachycardia over 90 bpm
  • Leukocytosis over 12 or under 4
131
Q

What is the mosquito that transmits malaria?

132
Q

Which strain of malaria carries the worst prognosis?

A

Falciparum

133
Q

What is the diagnostic test for malaria?

A

Giemsa or wright stained thick and thin blood filament

134
Q

What is the treatment for malaria?

A
  • Chloroquine
  • If vivax or ovale, use primaquine to kill liver infx
  • Atovaquone if chloroquine resistant area
135
Q

How long after initial infection can malaria cause s/sx?

A

immediately - Years

136
Q

What should be checked first in a pt with malaria who develops AMS?

A

Fingerstick BG

137
Q

What test can confirm a diagnosis of Mono if a heterophile spot is negative?

A

EBV antibodies

138
Q

What will a CBC often show with mono? (2)

A

Thrombocytopenia with lymphocytic lymphocytosis

139
Q

True or false: the rash that develops from EBV given PCN i pruritic

140
Q

What lethal GI complication can develop from EBV infx?

A

Fulminant hepatic necrosis

141
Q

True or false: fever of unknown origin always needs abx

A

False–not unless other s/sx of infx present

142
Q

What are the three 3’s of FUO diagnostic criteria?

A

Fever for 3 weeks that remains undiagnosed following 3 outpt visits, OR 3 days of hospitalization

143
Q

What is the definition of neutropenic fever?

A

Fever over 101 F (38.3 C) in a pt with neutropenia (less than 500 PMNs)

144
Q

Why should a rectal exam be deferred in a neutropenic patient?

A

Risk of thrombocytopenia and thus bleeding if anus is manipulated

145
Q

When should antifungals be started empirically in pts with neutropenic fever?

A

If febrile after 72 hours of abx therapy

146
Q

What antibiotics are indicated for treating neutropenic fever empirically?

A

Anti-pseudomonal (zosyn, aka piperacillin-tazobactam)

147
Q

What are the common s/sx of Ehrlichiosis?

A

HA, fever, chills, AMS and myalgias

148
Q

What are the lab abnormalities common to Ehrlichiosis? (3)

A

Leukopenia
Thrombocytopenia
elevated LFTs

149
Q

What is the treatment for Ehrlichiosis?

A

Doxycycline

150
Q

What is the tick that carries lyme disease?

A

Ixodes tick

151
Q

What are the s/sx of primary, secondary, and tertiary Lyme disease?

A
  1. Rash
  2. Migratory polyarthropathies, bells palsy, 3’ heart block
  3. Arthritis and encephalopathy
152
Q

When does IgM and IgG tests for lyme disease become positive?

A 
IgM = 1-2 weeks
IgG = 2-6 weeks
153
Q

What is the confirmatory test for lyme disease?

A

ELISA and (then) Western blot (Western blot alone has high false = rate)

154
Q

What is the treatment for early and late lyme disease?

A 
Early = doxycycline
Late = Ceftriaxone
155
Q

When is prophylaxis for lyme disease indicated? (3)

A
  • tick attached for over 36 hours
  • Within 72 hours of removal
  • Local rate of infx over 20%
156
Q

What are the characteristics of the rash of RMSF? How does the rash of RMSF spread?

A
  • Macular turns to petechial/purpuric

- Starts on the wrists, spreads centrally

157
Q

What is the treatment for RMSF in pregnant women?

A

Chloramphenicol

158
Q

What are the two major complications of RMSF?

159
Q

True or false: Neisseria conjunctivitis is an ocular emergency, and requires inpatient treatment

160
Q

What is the treatment for Neisseria conjunctivitis?

A

IV ceftriaxone

161
Q

What is the treatment for chlamydial conjunctivitis?

A

Azithromycin or tetracycline

162
Q

What is the abx of choice for otitis externa?

A

Topical ciprofloxacin

163
Q

What is the most common etiologic agent for endocarditis in the setting of

  • IV drug abuse
  • Dental procedures with native valves
  • Prosthetic valves
  • GI malignancy
  • fungal infx
A
  • IV drug abuse = staph aureus
  • Dental procedures with native valves = strep viridans
  • Prosthetic valves = staph epidermidis
  • GI malignancy = strep bovis
  • fungal infx = candida and aspergillus
164
Q

What are the HACEK organisms?

A 
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
165
Q

What is the empiric abx (2) for infective endocarditis?

A

Vanco and gentamicin

166
Q

What are the major (2) and minor (4) duke criteria for infective endocarditis?

A

major = Blood cultures + evidence of endocardial involvement

Minor =

  • risk factors +
  • Fever
  • Vascular phenomena
  • Immunologic phenomena
167
Q

When is preprocedure prophylaxis indicated for infective endocarditis?

A
  • Significant heart defects (prosthetic valves, unrepaired defect)
  • Undergoing high risk procedure
168
Q

What is the preferred abx for preprocedure prophylaxis for infective endocarditis?

A

Amoxicillin

169
Q

True or false: there is no person-person spread of anthrax

170
Q

What are the cutaneous characteristics of anthrax?

A
  • Pruritic papule the enlarges to forms an ulcer surrounded by a satellite/ bulbous lesions.
  • +regional LAD
  • Forms into black eschar
171
Q

What are the pulmonary manifestations of anthrax?

A

Hemorrhagic mediastinitis (no pulmonary infiltrates)

172
Q

What is the treatment for anthrax? Prophylaxis?

A

Ciprofloxacin for both

173
Q

What two labs are elevated with osteomyelitis?

A

CRP and ESR

174
Q

What are the XR findings of osteomyelitis?

A

Periosteal elevation

175
Q

How do you diagnose and treat osteomyelitis?

A
  • Bone aspiration (although increases risk for infection)

- Surgical debridement followed by IV Abx

176
Q

If a pt has a PCN allergy, but needs a beta lactam abx, which abx class has minimal cross reactivity?

A

Cephalosporins

177
Q

What are the common infectious agents implicated in osteomyelitis in the following contexts:

  • IV drug abuse
  • Sickle cell
  • Hip replacement
  • Foot puncture wound
  • DM
A
  • IV drug abuse = staph aureus
  • Sickle cell = salmonella
  • Hip replacement = staph epidermidis
  • Foot puncture wound = pseudomonas
  • DM = pseudomonas, staph, strep

A1 (32 decks)

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