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MS3 Year > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What separates severe sepsis from septic shock?

A

Severe sepsis is responsive to fluids while shock is not

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2
Q

Sepsis + low blood pressure, dx and next step?

A

Severe sepsis, give fluid bolus

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3
Q

What are the SIRS criteria (4)?

A

Temp gt 38 or lt 36
WBC gt 12 or lt 4
HR gt 90
RR gt 20

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4
Q

In sepsis, early goal directed therapy, what are the goals for CVP, MAP, Uoutput, and SvO2?

A

CVP 8-12
MAP gt 65 (use pressors if needed)
Uoutput gt 0.5 cc/kg/hr
SvO2 gt 70%

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5
Q

What are the main actions to take in patients with sepsis (6)?

A

1/2) Antibiotics and fluids; 3) Pressors (if in shock); 4) lactate (trend lactate for clearance); 5) Oxygen (improve oxygen delivery to tissues); 6) Source control (remove lines, catheters, drain abscesses)

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6
Q

Antibiotics for cholangitis?

A

gram negative and anaerobic coverage - cipro + metronidazole

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7
Q

Alternate for pip/tazo?

A

meropenem, cefepime

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8
Q

Antibiotics for community acquired pneumonia?

A

Ceftriaxone and azithromycin (moxifloxacin is appropriate)

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9
Q

Alternate for vancomycin?

A

Linezolid

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10
Q

Antibiotics for diverticulitis?

A

gram negative and anaerobic coverage - cipro + metronidazole

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11
Q

Antibiotics for a young woman with pyelonephritis but ambulatory and can tolerate po?

A

cipro

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12
Q

Antibiotics for health care associated pneumonia?

A

vanc + zosyn

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13
Q

Antibiotics for a young woman with pyelo who is toxic?

A

Ceftriaxone (pip/tazo also okay)

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14
Q

You woman with a UTI but no sepsis?

A

nitrofurantoin, TMP-SMX, amoxicillin

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15
Q

Alternate for ceftriaxone?

A

ceftazidime

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16
Q

CD4 count less than 100, what infxn do you worry about and what’s ppx? less than 50 and what’s ppx?

A

Toxo, TMP-SMX; MAC, Azithromycin

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17
Q

What test do you order when pt has flu-like symptoms, flu is negative, and the question is about HIV?

A

viral load (NOT an ELISA because it is too early for the antibody to be formed)

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18
Q

PCP prophylaxis if G6PD deficient?

A

atovaquone (both TMP-SMX and dapsone are no good)

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19
Q

White stuff you can easily scrape off the mouth, WITH dysphagia, what’s the dx and tx?

A

esophageal candidiasis, oral fluconazole (need systemic therapy!)

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20
Q

PCP prophylaxis with a sulfa allergy?

A

Dapsone

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21
Q

White stuff you can easily scrape off the mouth, no dysphagia, dx and tx?

A

oral candidiasis, nystatin swish and spit

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22
Q

CD4 count less than 200, what do you worry about and how do you ppx?

A

PCP, TMP-SMX

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23
Q

Uncomplicated vs complicated parapneumonic effusions: pleural fluid analysis: pH, glucose, WBC

A

uncomplicated: pH gt/= 7.2, glucose gt/= 60, WBC lt/= 50,000 (opposite for complicated)
(uncomplicated = sterile exudate in pleural space; complicated = bacterial invasion of pleural space - often loculated; gram stain often neg due to low bacterial count)

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24
Q

The PPD is 16 mm, who is that positive for?

A

People who have no risk factors

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25
Q

For immunocompromised, what is the lowest that a PPD is positive?

A

5mm

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26
Q

AFB smear is positive for TB, how do you tx?

A

Isolation and RIPE therapy

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27
Q

The PPD is 6mm. Who is that positive for?

A

Immunocompromised and close contacts to people with TB

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28
Q

How do we screen someone with a positive PPD in the past that was treated for TB?

A

Chest xrays

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29
Q

If a person has had BCG vaccine, how can you screen for TB?

A

Gamma interferon assay

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30
Q

PPD is positive, next step?

A

Chest xray

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31
Q

PPD is positive, chest X-ray is positive, next step?

A

AFB smear

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32
Q

PPD is positive, chest Xray is positive, AFB is negative, next step?

A

tx with INH and B6 for 9 months (also do same if PPD is positive and chest xr is negative)

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33
Q

Brain mass on CT, AIDS negative in vignette, next step?

A

biopsy (if they have AIDS and toxo ag is positive, tx for toxo)

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34
Q

What are the FAILS criteria and what is it for?

A 
To determine if an LP is safe to do
Focal neurologic deficit
Altered mental status
Immunocompromised
Lesion over site of LP
Seizures
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35
Q

Fever and a headache and positive FAILS, next step?

A

IV Abx, then CT scan

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36
Q

Brain mass on CT, AIDS positive in vignette, next step?

A

Treat for too 4-6 weeks

37
Q

Flaccid paralysis and encephalopathy, likely dx?

A

West Nile

38
Q

What is the empiric treatment for bacterial meningitis?

A

Vancomycin + ceftriaxone + steroids (+/- ampicillin for immunocompromised)

39
Q

Lyme meningitis - tx?

A

ceftriaxone

40
Q

Temporal lobe and encephalitis, likely dx?

A

HSV

41
Q

Fever and a headache, no fails criteria are positive, next step?

A

LP

42
Q

Tx for HSV encephalitis? West nile, St. Louis, or Equine encephalitis?

A

Acyclovir; tx is supportive

43
Q

Uncomplicated vs complicated parapneumonic effusions: pleural fluid analysis: pH, glucose, WBC

A

uncomplicated: pH gt/= 7.2, glucose gt/= 60, WBC lt/= 50,000 (opposite for complicated)

44
Q

Pneumonia in a dialysis pt? How do you tx?

A

HAP; vanco + zosyn

45
Q

Fever and a cough, consolidation on XR, not toxic, how do you tx?

A

azithromycin (+ceftriaxone?)

46
Q

Pneumonia in a nursing home pt: diagnosis/tx?

A

HAP; vanc + zosyn

47
Q

Fever and a cough, consolidation on X-ray, septic; how do you tx?

A

ceftriaxone and azithromycin

48
Q

Fever and a cough, no consolidation on X-ray, how do you tx?

A

doxycycline or azithromycin (po)

think bronchitis

49
Q

Pneumonia but foul breath and a CXR shows cavitation, dx and tx?

A

abscess; ceftriaxone (3rd gen ceph) + clindamycin

50
Q

Bilateral white out in an AIDS pt, dx and tx?

A

PCP; IV TMP-SMX + steroids (if PaO2 is less than 70)

51
Q

Healthy woman with pyelo, can tolerate po, tx and how long?

A

cipro x 7 days

ambulatory pyelo = complicated cystitis

52
Q

Woman with severe pyelo, tx and how long?

A

ceftriaxone IV x 10 days

53
Q

Healthy man with a UTI and no sepsis, tx and how long?

A

Nitrofurantoin x 7days (could also use TMP-SMX, fosfomycin)

complicated cystitis

54
Q

Healthy woman with a UTI and no sepsis, tx and how long?

A

Nitrofurantoin x3days (could also use TMP-SMX, fosfomycin)

55
Q

Three days into a pyelo dx and the pt hasn’t improved, next step?

A

CT scan (or U/S if pregnant) looking for perinephric abscess)

56
Q

White blood cell casts, likely dx?

A

pyelonephritis

57
Q

Positive urinary tract infxn on labs, pt asymptomatic, but pregnant, tx?

A

amoxicillin (nitrofurantoin if pen allergic)

58
Q

Positive urinary tract infxn on labs during a routine or screen, pt asymptomatic, tx?

A

do nothing

59
Q

Antibiotics for pyelonephritis?

A

If IV: ceftriaxone or amp-sulbactam

If po: ciprofloxacin

60
Q

Single painless ulcer with lymphadenopathy on penis? Dx? How to confirm dx? Tx?

A

primary syphilis; dark field microscopy; penicillin x1 IM

61
Q

Central umbilication?

A

Molluscum contagiosum

62
Q

Targetoid lesions on the palms and soles?

A

Syphilis (also erythema multiforme)

63
Q

Painful ulcer with lymphadenopathy on the vulva - organism and tx?

A

H. ducreyi; azithromycin

64
Q

How do you test an ulcer for herpes?

A

HSV PCR (not Tzanck prep or histology)

65
Q

Penicillin allergic and pregnant, treat tertiary syphilis with?

A

Desensitization

66
Q

Penicllin allergic and not pregnant, tx tertiary syphilis with?

A

Doxycycline

67
Q

Honey-crusted lesion, dx and tx?

A

Impetigo; amoxicillin

68
Q

Treat scabies with?

A

permethrin cream

69
Q

How to diagnose osteomyelitis with cellulitis?

A

xray, then MRI, then biopsy (no bone scan)

70
Q

Fungal skin infections that don’t involve the nail, how do you tx?

A

topical antifungals

71
Q

How to diagnose osteomyelitis without cellulitis?

A

xray, then bone scan, then biopsy (MRI is best for imaging??)

72
Q

Fungal skin infections that involve the nail, how do you tx?

A

oral medications - terbinafine is the best

73
Q

Rapidly spreading cellulitis with far more pain than should be present, dx and tx?

A

necrotizing fascitis; surgical debridement asap

74
Q

Gas on X-ray, dx?

A

gas gangrene (clostridium perfringens)

75
Q

Treat lice with?

A

permethrin shampoo

76
Q

A pt with a dental procedure, and prosthetic valves gets?

A

prophylactic amoxicillin

77
Q

Pt has bacteremia and a new murmur, what diagnostic step is next?

A

TEE

78
Q

How do you tx a pt with a vegetation (endocarditis lesion) greater than 15mm?

A

Surgery

79
Q

What’s the empiric prosthetic valve treatment (what does everyone get)?

A

vanc + gent;

cefepime if less than 60 days old; ceftriaxone if gt 365 days old

80
Q

What’s the empiric native valve endocarditis treatment?

A

vancomycin

81
Q

When do you get a CT scan for sinusitis?

A

recurrent or refractory - to look for anatomic defects

82
Q

Non-purulent rhinorrhea, no cough, congestion: dx and mgmt?

A

common cold; supportive: decogenstants are okay, NO antibiotics

83
Q

Purulent rhinorrhea, congestion, facial tenderness, and fever: dx and mgmt?

A

sinusitis

amoxicillin-clavulanate 1st line; levofloxacin if penicillin allergic

84
Q

Pain on pulling on the pinna, child swimmer, what is it and how to tx?

A

otitis externa, pseudomonas, cipro drops

85
Q

Common cold treatment?

A

supportive

86
Q

Best diagnostic test for dx of otitis media?

A

pneumatic insufflation

87
Q

Otitis externa is tx with?

A

cipro steroid drops

88
Q

Antibiotic mgmt for ENT infxns?

A

Amoxicillin first line; azithromycin if pen allergic; amoxicillin-clavulanate if refractory

MS3 Year (18 decks)

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