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MEDI IM shelf > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

MC meningitis bugs

A

strep pneumo

h. influenza
n. meningiditis

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2
Q

empiric tx meningitis

A

ceftriaxone

vancomycine

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3
Q

Meningitis in old and young

A

add lysteria

tx with ampicillin

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4
Q

Meningitis s/p brain surgery

A

add staph

tx with vanco

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5
Q

random meningitis

A

TB
tx with RIPE and roids

Lyme
IV ceftriaxone

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6
Q

meningitis best first step

A

Start empiric abx (+ setroids if you think it is bacterial)
Exam for elevated ICP/CT
LP

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7
Q

meningitis diagnostic test

A

+ gram stain

> 1000 WBC is diagnositc

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8
Q

roommate of the kid in the dorms who has bacterial meningitis and petechial rash

A

rifampin

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9
Q

classic sx pneumonia…1st step

A

CXR

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10
Q

MC bug of pneumonia

A

strep pneumo

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11
Q

Tx of MC pneumonia

A

ceftriax + azith

or levofloxcin

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12
Q

MC bug, healthy oung people

A

mycoplasma pneumo

assoc w/ cold agglutinins

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13
Q

Tx mycoplasma pna

A

azithro

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14
Q

Hospitalized within 3 mo or in the hospital > 5-7 d + sx pneumonia

A

pseudomonas, klebsiella, e. coli, MRSA

tx w/ pip/tazo or imipenem + vanc

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15
Q

old smokers with COPD PNA

A

h. influenza

tx with 2nd or 3rd gen ceph

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16
Q

alcoholics with currant jelly sputum

A

klebsiella typical

tx with 3rd gen ceph

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17
Q

old men with HA, confusion, diarrhea, and abd pain, and pneu?

A

legionella

dx with urine ag

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18
Q

Just had the flu, now pna

A

MRSA

tx with vaco

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19
Q

just delivered a baby cow and have vomiting, diarrhea, and pneumonia sx

A

Q-fever
Coxiella burnetti
tx with doxy

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20
Q

jusk skinned a rabbit and have pneumonia sx

A

franciella tularensis

tx with streptamycin/gentamycin

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21
Q

If a patient has TB and is symptomatic, get

A

CXR

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22
Q

TB screening, positive if…

A

> 15 mm
10 mm if in prison, HC, nursing home, DM, EtOH, chronically ill
5 mm for AIDS, IC

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23
Q

If positive PPD…get

A

CXR

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24
Q

If positive PPD and positive CXR…get

A

acid fast stain of sputum

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25
Q

If positive TB…tx

A

RIPE regimen x 6 mo
if pregnant x 9 mo
if TB meningitis x 12 mo

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26
Q

chemoprophylaxis for kiddos <4 yo exposed to known TB

A

INH x 9 mo

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27
Q

Exposure to TB ppx

A

INH

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28
Q

rifamipin SE

A

body fluids turn orange/red

induces CYP450

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29
Q

INH SE

A

peripheral neruopathy
sideroblastic anemia (give B6)
hepatitis with mild bump in LFTs

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30
Q

pyrazinamide SE

A

benign hyperuricemia

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31
Q

ethambutol SE

A

optic neuritis, other color vision abnL

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32
Q

MC bug acute IE

A

staph aureus

able to seed native valve from bacteremia

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33
Q

subactue native valve IE…
MC valve
MC bug

A

mitral valve (MVP)

strep viridans

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34
Q

IV drug user IE…
MC valve
MC bug

A

tricuspid valve

staph aureus

35
Q

IE dx

A 
blood culture
TTE
then TEE
Major criteria
Minor criteria
36
Q

IE complications

A

CHF #1 COD

septic emboli to lungs or brain

37
Q

IE tx

A

s. viridans… penicillin x 4-6w

s. aureus…naficillin + gentamicin or vanco

38
Q

IE ppx indications

A

if prosthetic valve
hx IE
uncorrected congenital lesion

39
Q

What if you find strep bovis bacteremia?

A

next step…colonoscopy!!!

40
Q

When to suspect HIV…

A

it a patient “travels a lot for work” –> that means they have sex with lots of strangers and are at risk for HIV

41
Q

Acute retroviral syndrome

A

2-3 w s/p exposure
BUT 3 wk before seroconversion
–> ELISA negative

42
Q

A young patient with new/bilateral Bell’s palsy…r/o

A

HIV

43
Q

A young patient with unexplained thrombocytopenia and fatigue…r/o

A

HIV

44
Q

A young patient with unexplained weight loss > 10%…r/o

A

HIV

45
Q

A young patient with thrush, Zoster, or Kaposi sarcoma… think

A

HIV

46
Q

When to start tx/post exposure ppx for HIV

A

HAART when:

  • CD4 < 350
  • viral load > 55,000 copies
  • preg and viral load > 1,000 copies
47
Q

HAART SE: gi + leukopenia + macrocytic anemia

A

zidovudine

48
Q

HAART SE: pancreatitis + peripheral neuropathy

A

didanosine

49
Q

HAART SE: HS rash, fever, n/v, muscle aches, SOB in 1st 6wks

A

abacavir

D/c and NEVER USE AGAIN

50
Q

HAARD SE: sleep, confused, psycho

A

efavirenz

51
Q

Post-exposure ppx after stuck by needle from known HIV pt

A

AZT
lmivudine
nelfinavir
x 4 w

52
Q

HIV + with DOE, dry cough, fever, and CP…think and best test

A

PCP
CD4 prop < 200

CXR
then bronchoscopy with BAL to visualize bug

53
Q

PCP on CXR

A

bilateral diffuse symmetric interstitial infiltrates

54
Q

PCP 1st line tx

A

Bactrim

55
Q

PCP 2nd line tx

A

TMP-dapsone
primaquine-clindamycin
OR
pentamidine

56
Q

PCP tx, when to add steroids?

A

When PaO2 < 70%

A-a gradient > 35

57
Q

PCP ppx

A

Start when CD4 < 200
(can D/C if > 200 x 6 mo)

  1. Bactrim
  2. Dapsone
  3. Atovaquone
  4. Aerosolized pentamidine (can cause pancreatitis)
58
Q

HIV + with diarrhea…and CD < 50…

A

CMV
MAC
cryptoscopridium

59
Q

HIV + with CMV GE dx and tx

A

colonoscopy/biopsy

gancicylovir
OR foscarnet

60
Q

SE ganciclovir

A

neutropenia

61
Q

SE foscarnet

A

renal toxicity

62
Q

HIV+ with MAC GE sx/dx

A

diarrhea
wasting
fevers
night sweats

63
Q

HIV+ with MAC GE tx and ppx

A

clarithryomycin
ethambutol
+/- rifampin

ppx w/ azithro weekly

64
Q

HIV+ and cryptosporidium GE how and sx

A

dogg poo, swimming pools, dirty water

watery, mucous diarrhea
ooxysts are acid fast

65
Q

HIV+ with neuro sx and multiple ring enhancing lesions on head imaging…think

A

Toxoplasmosis

66
Q

HIV+ toxo tx

A

empiric pyramethamine sulfadizaine (+ folic acid) x 6 w

If no improvement in 1 wk,
consider biopsy for CNS lymphoma

67
Q

HIV+ with neuro sx and one ring enhancing lesions on head imaging…think and tx

A

CNS lymphoma

assoc. with EBV infection and B-cells

Tx w/ HAART

68
Q

HIV+ with seizure w/ de ja vu aura and 500 RBCs in CSF…think and tx

A

HSV encephalitis
(predisposed for temporal lobe)

Tx: acyclovir ASAP expected

69
Q

HIV+ if s/s of meningitis…think and tx

A

cryptococcus (pigeons!)

+ India ink

tx w/ amphotericin B IV x 2 w
THEN fluconazole PO maint

70
Q

HIV+ with hemisensory loss, visual impairment, Babinski…think and dx

A

PML

JC polymomarvirus demyelinates at grey-white jxn

Brain bx is gold standard dx

71
Q

HIV+ and memory problems or gait disturbance…think and dx

A

AIDS-dementia complex

serum, CSF, and MRI to r/o treatable causes

72
Q

Neutropenic fever is…

A

a MEDICAL EMERGENCY!

ANC < 500
single temp 101.3 or sustained temp > 100.4 for 1 hr

73
Q

Neutropenic fever….never do

A

DRE

74
Q

MC bugs in neutropenic fever…

A 
pseudomonas
MRSA (if port present)
75
Q

Neutropenic fever workup

A
  1. blood culture

2. 3rd (ceftazidime) or 4th (cefepime) gen cephalosporin

76
Q

neutropenic fever…add vancomycin if…

A

line infection suspected
OR
septic shock develops

77
Q

neutropenic fever…add amphotericin B if…

A

no improvement and no source found in 5 days

78
Q

target rash + fever + VII palsy + meningitis + AV block

A

Lyme dz

doxy

79
Q

Lyme dz tx

A

doxycycline!
if < 8 yo, amoxicillin
if heart or CNS dz, IV ceftriaxone

80
Q

rash at wrists and ankles + palms and soles + fever + HA

A

Rickettsia

doxy

81
Q

tick bite + no rash + myalgia + fever + HA + thrombocytopenia + leukopenia + elevated ALT

A

Ehrlichiosis

dx with morulae intracellular inclusion

doxy

82
Q

IC + cavitary lung dz + purulent sputum + wt loss + fever + gram pos aerobic branching/partially acid fast

A

Nocardia

bactrim

83
Q

neck or face infection + draining yellow + sulfur granules + gram + anerobic branching

A

Actinomyces

high dose penicillin x 6-12 w

MEDI IM shelf (6 decks)

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