Infectious disease Flashcards by Hailey Roberts

MC meningitis bugs

strep pneumo

h. influenza
n. meningiditis

How well did you know this?

Not at all

Perfectly

empiric tx meningitis

ceftriaxone

vancomycine

How well did you know this?

Not at all

Perfectly

Meningitis in old and young

add lysteria

tx with ampicillin

How well did you know this?

Not at all

Perfectly

Meningitis s/p brain surgery

add staph

tx with vanco

How well did you know this?

Not at all

Perfectly

random meningitis

TB
tx with RIPE and roids

Lyme
IV ceftriaxone

How well did you know this?

Not at all

Perfectly

meningitis best first step

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

How well did you know this?

Not at all

Perfectly

meningitis diagnostic test

+ gram stain

> 1000 WBC is diagnositc

How well did you know this?

Not at all

Perfectly

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

rifampin

How well did you know this?

Not at all

Perfectly

classic sx pneumonia…1st step

CXR

How well did you know this?

Not at all

Perfectly

MC bug of pneumonia

strep pneumo

How well did you know this?

Not at all

Perfectly

Tx of MC pneumonia

ceftriax + azith

or levofloxcin

How well did you know this?

Not at all

Perfectly

MC bug, healthy oung people

mycoplasma pneumo

assoc w/ cold agglutinins

How well did you know this?

Not at all

Perfectly

Tx mycoplasma pna

azithro

How well did you know this?

Not at all

Perfectly

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

pseudomonas, klebsiella, e. coli, MRSA

tx w/ pip/tazo or imipenem + vanc

How well did you know this?

Not at all

Perfectly

old smokers with COPD PNA

h. influenza

tx with 2nd or 3rd gen ceph

How well did you know this?

Not at all

Perfectly

alcoholics with currant jelly sputum

klebsiella typical

tx with 3rd gen ceph

How well did you know this?

Not at all

Perfectly

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

legionella

dx with urine ag

How well did you know this?

Not at all

Perfectly

Just had the flu, now pna

MRSA

tx with vaco

How well did you know this?

Not at all

Perfectly

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

Q-fever
Coxiella burnetti
tx with doxy

How well did you know this?

Not at all

Perfectly

jusk skinned a rabbit and have pneumonia sx

franciella tularensis

tx with streptamycin/gentamycin

How well did you know this?

Not at all

Perfectly

If a patient has TB and is symptomatic, get

CXR

How well did you know this?

Not at all

Perfectly

TB screening, positive if…

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

How well did you know this?

Not at all

Perfectly

If positive PPD…get

CXR

How well did you know this?

Not at all

Perfectly

If positive PPD and positive CXR…get

acid fast stain of sputum

How well did you know this?

Not at all

Perfectly

If positive TB...tx

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

chemoprophylaxis for kiddos <4 yo exposed to known TB

INH x 9 mo

Exposure to TB ppx

INH

rifamipin SE

body fluids turn orange/red | induces CYP450

INH SE

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

pyrazinamide SE

benign hyperuricemia

ethambutol SE

optic neuritis, other color vision abnL

MC bug acute IE

staph aureus | able to seed native valve from bacteremia

subactue native valve IE... MC valve MC bug

mitral valve (MVP) strep viridans

IV drug user IE... MC valve MC bug

tricuspid valve staph aureus

IE dx

``` blood culture TTE then TEE Major criteria Minor criteria ```

IE complications

CHF #1 COD | septic emboli to lungs or brain

IE tx

s. viridans... penicillin x 4-6w | s. aureus...naficillin + gentamicin or vanco

IE ppx indications

if prosthetic valve hx IE uncorrected congenital lesion

What if you find strep bovis bacteremia?

next step...colonoscopy!!!

When to suspect HIV...

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

Acute retroviral syndrome

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

A young patient with new/bilateral Bell's palsy...r/o

HIV

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

HIV

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

HIV

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

HIV

When to start tx/post exposure ppx for HIV

HAART when: - CD4 < 350 - viral load > 55,000 copies - preg and viral load > 1,000 copies

HAART SE: gi + leukopenia + macrocytic anemia

zidovudine

HAART SE: pancreatitis + peripheral neuropathy

didanosine

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

abacavir | D/c and NEVER USE AGAIN

HAARD SE: sleep, confused, psycho

efavirenz

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

AZT lmivudine nelfinavir x 4 w

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

PCP CD4 prop < 200 CXR then bronchoscopy with BAL to visualize bug

PCP on CXR

bilateral diffuse symmetric interstitial infiltrates

PCP 1st line tx

Bactrim

PCP 2nd line tx

TMP-dapsone primaquine-clindamycin OR pentamidine

PCP tx, when to add steroids?

When PaO2 < 70% | A-a gradient > 35

PCP ppx

Start when CD4 < 200 (can D/C if > 200 x 6 mo) 1. Bactrim 2. Dapsone 3. Atovaquone 4. Aerosolized pentamidine (can cause pancreatitis)

HIV + with diarrhea...and CD < 50...

CMV MAC cryptoscopridium

HIV + with CMV GE dx and tx

colonoscopy/biopsy gancicylovir OR foscarnet

SE ganciclovir

neutropenia

SE foscarnet

renal toxicity

HIV+ with MAC GE sx/dx

diarrhea wasting fevers night sweats

HIV+ with MAC GE tx and ppx

clarithryomycin ethambutol +/- rifampin ppx w/ azithro weekly

HIV+ and cryptosporidium GE how and sx

dogg poo, swimming pools, dirty water watery, mucous diarrhea ooxysts are acid fast

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

Toxoplasmosis

HIV+ toxo tx

empiric pyramethamine sulfadizaine (+ folic acid) x 6 w If no improvement in 1 wk, consider biopsy for CNS lymphoma

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

CNS lymphoma assoc. with EBV infection and B-cells Tx w/ HAART

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

HSV encephalitis (predisposed for temporal lobe) Tx: acyclovir ASAP expected

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

cryptococcus (pigeons!) + India ink tx w/ amphotericin B IV x 2 w THEN fluconazole PO maint

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

PML JC polymomarvirus demyelinates at grey-white jxn Brain bx is gold standard dx

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

AIDS-dementia complex serum, CSF, and MRI to r/o treatable causes

Neutropenic fever is...

a MEDICAL EMERGENCY! ANC < 500 single temp 101.3 or sustained temp > 100.4 for 1 hr

Neutropenic fever....never do

DRE

MC bugs in neutropenic fever...

``` pseudomonas MRSA (if port present) ```

Neutropenic fever workup

1. blood culture | 2. 3rd (ceftazidime) or 4th (cefepime) gen cephalosporin

neutropenic fever...add vancomycin if...

line infection suspected OR septic shock develops

neutropenic fever...add amphotericin B if...

no improvement and no source found in 5 days

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

Lyme dz doxy

Lyme dz tx

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

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

Rickettsia doxy

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

Ehrlichiosis dx with morulae intracellular inclusion doxy

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

Nocardia bactrim

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

Actinomyces high dose penicillin x 6-12 w