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MTBs Step 2CK > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

what are the FAILS criteria? what are they used for?

A 
if any of the fails + then dnt do a LP and do a CT first.
FND
AMS
Immunocompromised
Lesions
Seizures
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2
Q

common meningitis caused by gram + diplococci

A

pneumococcus

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3
Q

common meningitis caused by gram - diplococci

A

neisseria

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4
Q

common meningitis caused by gram - pleomorphic, coccobacillary organism

A

Haemophilus

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5
Q

common meningitis caused by gram positive bacilli

A

listeria

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6
Q

what type of meningitis is associated with…. young kid with petechial rash

A

meningitidis

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7
Q

what type of meningitis is associated with….elderly, neonatal or HIV +

A

listeria

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8
Q

what type of meningitis is associated with….HIV positive with <100 CD4

A

cryptococcus

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9
Q

what type of meningitis is associated with….recently been camping

A

lyme

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10
Q

what type of meningitis is associated with….recently been camping or hiking with a rash starting on the wrist + ankles that is moving centripetally tword the center

A

rickettsia!

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11
Q

Viral vs bacterial meningitis vs crypto/lyme/rickettsia vs TB
cell count, protein, glucose, stain

A

Bacteria: 1000s neutrophils, elevated protein, dec glucose & + stain.

**all the rest have low(10s-100s) lymphocytes

  • Viral: all normal
  • Crypto/lyme/rickettsia: elevated glucose and protein.
  • TB: HIGH protein, slightly low glucose
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12
Q

Tx of bacterial meningitis

A

ceftriaxone+vancomycin + steroids

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13
Q

tx of bacterial meningitis in immunocomp pt

A

ceftriaxone+ vancomycin + steroids + AMPICILLIN for listeria coverage

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14
Q

Tx of Rickettsia meningitis

A

doxycyclin

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15
Q

tx of lyme meningitis

A

ceftriaxone

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16
Q

tx of cryptococcus meningitis

A

amphotericin & 5FU + fluconazole

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17
Q

Meningitis vs Encephalisits

A

Meningitis: FND, Papilledema, seizures, AMS, fever, HA, STIFF NECK, photophobia

Encephalitis: Fever + CONFUSION

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18
Q

if you suspect encephalitis what 2 test do u wanna run?

A

Head CT > PCR of CSF to confirm HSV(MC)

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19
Q

Tx of herpes encephalitis? what if its resistant?

A
  1. Acyclovir

if resistant = Foscarnet

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20
Q

woman has HSV encephalitis & is being treated with standard medication but her Creatinine level rises. what do you do?

A

reduce acyclovir and hydrate = she needs to get rid of the HSV! dnt switch to foscarnet bc thats worse on the kidneys than acyclovir

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21
Q

arthralgia, myalgia, cough, headache, fever, sore throat and feeling of tiredness. dx? what if your unsure of the dx how would you confirm?

A

flu!

*confirm w/nasopharyngeal swab of rapid antigen detection

if your sure about dx u can treat

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22
Q

how do you tx the flu?

A

if within 48hrs of the start of sx tx with Oseltamivir or zanamivir.

If more than 48 = symptomatic tx, anaglesia *only lasts about 5 days

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23
Q

which neurominidase inhibitors only work against influenza A and shouldnt be used for the seasonal flu?

A

amantidine and rimantadine

*use oseltamivir and zanamivir for the seasonal flu as it covers both A & B

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24
Q

ppl who get the flu and die usually die due to…

A

pneumonia

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25
Q

causes of bloody diarrhea

A

campylobacter, salmonella, vibrio, e.Coli, shigella, yersinia, amebic

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26
Q

What is the best initial treatment for severe diarrhea(blood, fever, abdominal pain, hypotension, tacycardia) if you dnt know the cause?

A

FQ like ciprofloxacin

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27
Q

sx of acute heptatitis

A

jaundice, fatigue, weight loss, dark urine caused by increased bilirubin in urine

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28
Q

which type of hepatitis can be deadly in pregnant women?

A

hepatitis E

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29
Q

which is elevated more AST or ALT in hepatitis/

A

ALT > AST

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30
Q

you will see osteomyelitis most commonly in patients with…

A

DM, PAD, or ulcer or soft tissue infection

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31
Q

what is the best initial test for OM? 2nd test? most accurate?

A

Xray > MRI > bone bx

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32
Q

what is the MC mechanism of spread of infection to bone?

A

OM caused by direct contiguous spread from teh overlying tissue to the bone.

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33
Q

MCC of osteomyelitis?

A

staphylococcus

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34
Q

tx of osteomyelitis?

A

4-6 weeks with vancomycin + pip/tazo untill cultures return

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35
Q

tx of otitis externa?

A

topical abx(ofloxacin, ciprofloxacin) + topical hydrocortisone to decrease swelling

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36
Q

tx of otitis media

A

augmentin or cefdinir

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37
Q

tx of sinusitis?

A

augmentin

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38
Q

Tx of urethritis &/or Cervicitis

A

Ceftriazone IM + Azithromycin 1x and then Doxy for 7days

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39
Q

Tx of Urethritis &/or Cervicitis in prego?

A

Ceftriazone IM + Azithromycin

*no doxy bc can mess with baby bones + teeth

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40
Q

outpatient treatment for PID

A

Ceftriaxone IM and Doxy oral or cefoxatine

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41
Q

inpatient treatment for PID

A

Cefoxitin or Cefotetan IV and doxy

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42
Q

what drugs are safe in prego?

A

PCNs, Cephalosporin, Aztreonam, Erythromycin, Azithromycin

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43
Q

PID sx? dx?

A

lower abdominal pain, tenderness, fever, cervical motion tenderness**, leukocytosis

  1. PREGO tests 2. cervical culture and NAAT test
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44
Q

sx of Epididymo-Orchitis

A

painful and tender testicle with a *normal position in the scrotum

*different from torsion bc torsion would be elevated and horizontal position

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45
Q

tx of Epididymo-Orchitis

A

<35yoa = Ceftriaxone and doxy

>35 yoa = FQ

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46
Q

Chancroid v syphilis v lymphogranuloma venereum v HSV ulcers sx?

A 
Chancriod = painful ulcers
Syphilis = painless ulcers
Lymph = painful LYMPH
HSV = painless lymph + painful ulcer
47
Q

Tx of Chancroid?

A

PO azithromycin 1x OR IM ceftriaxone

48
Q

Tx of Lymphogranuloma venereum?

A

Aspirate the bubo then doxy or azith

*remember this is chlamydia trachomatis

49
Q

tx of HSV ulcers?

what if resistant?

A

acyclovir! resistant do ganciclovir

50
Q

tx of syphillis ulcers?

A

IM PCN

51
Q

what is a Jarisch-Herxheimer Reaction?

A

fever, HA and myalgia developing 24 hrs after starting PCN for syphillis due to pyrogens being released from dying treponemal (can occur with any spirochete)

52
Q

What is Argyll-Robertson Pupil?

A

eyes accommodate to objects but do not respond to light.

53
Q

What is Tabes Dorsalis?

A

loss of position and vibratory sense, incontinence and CN abnormalites due to syphilis involving the posterior colums

54
Q

BIG BEEFY ulcer on genital/perineum? dx?

A

Granuloma Inguinale = Klebsiella Granulomatis

*this is BIG & BEEFY

55
Q

tx of Granuloma Inguinale

A

Doxy, TMP/SMX or Azith

56
Q

sx of Pediculosis?

A

aka CRABS

larger than scabies, in hair-bearing areas such as the pubic or axilla, visible on the surface

57
Q

tx of Pediculosis

A

Permethrin > Lindane

58
Q

Sx of Scabies

A

smalle, burrows in webs of fingers, scrape and magnify

59
Q

tx of Scabies

A

Permethrin > Lindane

*same as pediculosis

60
Q

how do you dx warts?

A

BY HOW THEY LOOK! you ndt need to bx a wart! regardless of what caused it (HPV, Molluscum, etc)

61
Q

tx for warts

A

cryotherapy, laser removal, melting with trichloroacetic acid

62
Q

how do you treat widespread scabies(like total body scabies)

A

Ivermectin

63
Q

sx of cystitis? MCC?

A

urinary frequency, urgency, burning, and dysuria

MCC = E.Coli

64
Q

tx of uncomplicated cystitis? what if its resistant?

A

tx Fosfomycin or Nitrofurantoin PO 3d

resistant: Ciprofloxacin or Levofloxacin

65
Q

tx of complicated cystitis?

A

7d TMP/SMX or ciprofloxacin

66
Q

how do you dx cystitis?

A

U/S&raquo_space;Culture

*if you highly suspect cystitis = go ahead and initiate tx. you can change later if resistant

67
Q

tx of pyelonephritis?

A

ciprofloxacin

inpatient: ciprofloxacin, ampicillin + gentamicin

=these are all excreted in high concentration in urine =)

68
Q

Acute Prostatitis dx?

A

tender prostate on exam! “boggy”

tx just like pyelo just longer!

69
Q

tx of acute prostatitis?

A

TMP/SMX or Ciprofloxacin for 6-8 weeks

70
Q

how do you workup perinephric abscess?

A

aka kidney abscess! *someone with pyelo that didnt resolve within 5-7days.

–> Sonogram or CT + drainage + Culture + retreat with ABX

71
Q

how do you dx infective endocarditis?

A

1st = blood culture and vegitations on heart valve

or use Dukes criteria

72
Q

whats the most likely dx? how do you work up?

pt with fever + new murmer

A

endocarditis = do blood culture first and if postive follow up with echocardiogram to look for vegitations

73
Q

sx of CHRONIC endocarditis

A

roth spots(retina), janeway lesions(flat, painless in hands and feet), Osler’s nodes(raised, painful, and pea shaped), *splinter hemorrhages(under fingernails)

*MC!

74
Q

best empiric therapy for endocarditis?

A

vancomycin + gentamicin

75
Q

A man comes into the ED with fever and a murmer. blood cultures grow strep bovis. TEE shows vegitation. whats the next best step in management?

A

COLONOSCOPY to look for pathology!

*bovis and colostridium are associated with colonic pathology and you gotta find it!

76
Q

When do you need to ppx for endocarditis?

A

anyone with valve dz, previous endocarditis/dmg or prosthetic valve = ppx for…

  1. dental procedures that cause bleeding
  2. respiratory tract surgery
  3. surgery or skin infection
77
Q

how do you ppx for endocarditis for dental/oral procedures? alternative?

A

Amoxicillin
If PCN rash: cephalexin
If anaphylax: Azithromycin, clarithromycin or clindamycin

78
Q

how do you ppx for endocarditis for skin procedures? alternative?

A

cephalexin

if allergic: vancomycin

79
Q

endocarditis with MRSA tx

A

Vancomycin alone is enough

80
Q

endocarditis with a fungus tx?

A

amphotericin

81
Q

MCC of culture negative endocarditis?

A

Coxiella

82
Q

HACEK

^whats this for? whats it mean? tx?

A 
difficult to culture endocarditis:
Haemophilus aphrophilus/parainfluenza
Actinobacillus
Cardiobacterum
Eikenella
Kingella

**tx w/Ceftriaxone

83
Q

when should you use rifampin for endocarditis

A

with prostetic valves and staph infection

84
Q

sx of lyme

A

stage 1: fever + target rash/erythema migrans
stage 2:AV heart block, bells palsy
stage 3: arthralgias, confusion

85
Q

tx of nonCNS lyme

A

doxy, amox or cefuroxime

86
Q

tx of CNS lyme

A

ceftriaxone

87
Q

HIV/AIDS transmission

A

IDU, Sex, Transfusion, Perinatal & breastfeeding, Needle stick

88
Q

can kissing transmit HIV?

A

no!

89
Q

when do you start HIV therapy?

A

ideally when you know u have the virus! if <500 CD4 you MUST start!, any1 who is symptomatic and pregnant women

90
Q

best dx test for HIV?

A

ELISA = enzyme linked immunosorbent assay & confirmed with western blot.

91
Q

best dx test for HIV in an infant?

A

PCR or viral culture

*cant depent on ELISA bc baby has all of moms ab so its gonna be positive no matter what

92
Q

PrEP for HIV

A

ET = Tenofovir & Emtricitabine before exposure and 1 month after exposure

93
Q

PEP for HIV

A

ART for a month taht needs to be started within 72 hrs

94
Q

initial HIV therapy?

A

2 NRTIs and an Integrase inhibitor

95
Q

PCP ppx in HIV <200

A

TMP/SMX

96
Q

MAC ppx in HIV <50

A

Azithromycin 1x wk PO

97
Q

tx of Impetigo?

A

topical mupirocin if severe use dicloxacillin or cephalexin

98
Q

tx of erysipelas

A

*caused by GAS = really red skin infection

oral docloxacillin or cephalexin

99
Q

tx of cellulitis

A

augmentin, cefazolin

100
Q

topical antifungal skin tx? when do you use this?

A

use this if no nails or hair is involved = clotrimazole, nystatin, ketoconazole

101
Q

topical antifungal tx when hair/scalp or nails are involved?

A

terbinafine, itraconazole, griseofulvin

102
Q

tx of leptospirosis

A

ceftriaxone or PCN

103
Q

tx of tularemia

A

doxy, genta or strepto

104
Q

tx of plague

A

streptomycin, genta, doxy

105
Q

tx of brucellosis

A

doxy + genta

106
Q

tx of bartonella via bite & via scratch

A

bite: augmentin
scratch: doxy or azithro

107
Q

tx of anthrax

A

FQ or Doxy

108
Q

tx of babesiosis

A

azithromycin or atovaquone

109
Q

tx of acute malaria? tx of severe malaria?

A

acute: mefloquinie
severe: artemisinins

110
Q

tx of nocardia

A

TMP/SMX

111
Q

tx of actinomyces

A

PCN

112
Q

tx of histoplasmosis, and blastomycosis

A

amphotericin

113
Q

tx of coccidioidomycosis

A

itraconazole

114
Q

tx of aspergillus

A

voriconazole

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