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IM Essentials > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Diagnosis:

  1. Hyperthermia/fever
  2. Muscle rigidity
  3. Cognitive changes
  4. Shivering*
  5. Hyperreflexia*
  6. Myoclonus* (involuntary twitch or jerk)
  7. Ataxia*
A

Serotonin Syndrome

*Shivering, hyperreflexia, myoclonus and ataxia are especial to serotonin syndrome.

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2
Q

Diagnosis:

  1. Hyperthermia/fever
  2. Muscle rigidity
  3. Cognitive changes
  4. Autonomic instability (dizziness, orthostatic hypotension, etc.)
  5. Diaphoresis
  6. Sialorrhea (hypersalivation)
  7. Seizures
  8. Cardiac arrhythmias
  9. Rhabdomyolysis
A

Neuroleptic malignant syndrome

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3
Q

What types of drugs predisposed patients to the development of neuroleptic malignant syndrome?

A

Dopamine receptor antagonists

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4
Q

When should you suspect drug fever in a patient?

A

Suspect drug fever in patients who recently started treatment with a new drug (usually an antibiotic) and have fever without other signs of infection or inflammation.

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5
Q

When do you prescribe antibiotics to treat sinusitis?

A
  1. 3-4 days of severe symptoms (temp >/= 39.0, purulent discharge, facial pain)
  2. Worsening of symptoms that were initially improving after a URI
  3. Symptoms that do not improve after 10 days
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6
Q

What is the Centor criteria?

A

The four-point Center criteria is a reasonable way to triage patients with pharyngitis to either empiric treatment with antibiotics, symptomatic treatment only or testing with treatment if the test result is positive.

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7
Q

What are the four-point Centor criteria?

A
  1. Temperature >38.1 C
  2. Tonsillar exudates
  3. Tender cervical lymphadenopathy
  4. Absence of cough
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8
Q

Diagnosis:

  1. Otalgia
  2. Itching or fullness
  3. Pain intensified by jaw motion

Physical Examination:

  1. Internal tenderness when the tragus or pinna is pushed or pulled
  2. Diffuse ear canal edema
  3. Purulent debris
  4. Erythema
A

Acute otitis externa

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9
Q

Signs/Symptoms:

Acute otitis externa

A
  1. Otalgia
  2. Itching or fullness
  3. Pain intensified by jaw motion
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10
Q

Physical Examination Findings:

Acute otitis externa

A
  1. Internal tenderness when the tragus or pinna is pushed or pulled
  2. Diffuse ear canal edema
  3. Purulent debris
  4. Erythema
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11
Q

Treatment:

Otitis media with URI

A

Observation

Do not routinely prescribe antibiotic therapy for adults with otitis media.

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12
Q

When should you suspect Lemierre syndrome?

A

In patients with:

  1. Pharyngitis
  2. Persistent fever
  3. Neck pain
  4. Septic pulmonary emboli
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13
Q

What is Lemierre syndrome?

A

Septic thrombosis of the jugular vein

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14
Q

Treatment:

Pseudomonas Aeruginosa pneumonia

A

Beta-lactam + aminoglycoside
(i.e. piperacillin-tazobactam + amikacin)

Initial empiric therapy with two anti-pseudomonal agents should be initiated in patients with risk factors for Pseudomonas pneumonia.

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15
Q

What are the risk factors for Pseudomonas Aeruginosa?

A
  1. History of smoking
  2. Chronic lung disease
  3. Use of broad-spectrum antibiotics in the previous month
  4. Recent hospitalization
  5. Malnutrition
  6. Neutropenia
  7. Glucocorticoid use
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16
Q

What prognostic models can you use to determine which patients with community-acquired pneumonia are at risk for complications and require hospitalization?

A
  1. CURB-65

2. Pneumonia Severity Index

17
Q

What are the CURB-65 criteria?

A 
Confusion
blood Urea nitrogen >19.6
Respiration rate >/= 30/min
systolic Blood pressure<90mmHg or diastolic <60 mmHg 
Age>/=65

Admit for scores >2.

18
Q

What CURB-65 score indicates the need for:

  1. Hospitalization
  2. Admission to ICU
A
  1. 2 or more

2. 3 or more

19
Q

Treatment:

Outpatient community-acquired pneumonia

A

Azithromycin

Ensure patient does not have risk factors for Streptococcus pneumonia infection.

20
Q

List the risk factors for drug–resistant Streptococus pneumoniae infection.

A
  1. Age >65 years old
  2. Beta-lactam therapy in they last 3 months
  3. Medial comorbidities
  4. Immunocompromising conditions and immunosuppressive therapy
  5. Alcoholism
  6. Exposure to a child in day care
21
Q

Work-up:

Severe community acquired pneumonia

A
  1. Blood cultures
  2. Urine antigen assays for Legionella and Streptoccocus pneumonia
  3. Endotracheal aspirate for Gram stain and culture
22
Q

Define severe community-acquired pneumonia (CAP).

A

CAP in a patient who requires admission to the ICU (CURB-65 score of 3 or more) or transfer to an ICU within 24 hours of admission.

23
Q

How do you manage a patient hospitalized with bacteremic community-acquired pneumonia who has responded promptly to therapy?

A

Discharge home on oral medications once they are clinically stable.

Amoxicillin x7days is sufficient.

24
Q

When is the interferon-gamma-releasing assay preferred over the tuberculin skin test?

A
  1. In patients who have received the Bacillus Calmette-Guerin (BCG) vaccine.
  2. Patients who do not return for follow-up reading of the tuberculin skin test.
25
Q

How do you interpret the Mantoux tuberculin skin test (TST)?

A

Criteria for positivity are based on the patients risk factors for infection with Mycobacterium tuberculosis.

Induration 5mm or greater is positive in (HIV–positive persons; recent contacts of persons with active tuberculosis; fibrotic changes on chest radiograph consistent with previous tuberculosis infection; patients with organ transplants or immunosuppressive conditions)

Induration 10mm or great is positive in (<5years since arrival from a high-prevalence country; injection drug users; residents or employees of high risk conjugate settings; people with clinical conditions that put them at high risk for active disease; children younger than 4 or exposed to adults in high-risk categories)

Induration 15mm or greater is positive in all other persons.

26
Q

What testing is required before the administration of a biologic agent for immunosuppression?

A

Testing for tuberculosis with a tuberculin skin test or the interferon-gamma-releasing assay.

27
Q

Treatment:

Adult with previously untreated tuberculosis

A

2-month initial phase treatment with:

  1. Isoniazid
  2. Rifampin
  3. Pyrazinamide
  4. Ethambutol

7-month treatment with isoniazid and rifampin if susceptible TB.

28
Q

Treatment:

Susceptible TB

A
  1. Isoniazid

2. Rifampin

29
Q

Treatment:

Latent tuberculosis infection in a patient high risk for active tuberculosis

A

Isoniazid for 9 months

Treatment may reduce the risk of active disease by up to 90%.

30
Q

Treatment:

Antibiotic prophylaxis to prevent infective endocarditis in a patient with a heart murmur and native valve abnormality

A

None

Antibiotic prophylaxis is only recommended for patients with underlying conditions associated with the highest risk or adverse outcomes.

31
Q

Treatment:

methicillin-resistant Staphylococcus aureus native valve infective endocarditis

A

IV vancomycin or daptomycin

32
Q

What are the indications for infective endocarditis prophylaxis for patients before certain dental or surgical procedures.

A

Prophylaxis is needed in patients with:

  1. Prosthetic cardiac valves
  2. Hx of infective endocarditis
  3. Unrepaired cyanotic congenital heart disease
  4. Congenital heart disease repair with prosthetic materials or device within the last 6 months
  5. Palliative shunts and conduits
  6. Cardiac valvulopathy in cardiac transplant recipients

IM Essentials (4 decks)

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