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Infectious disease Flashcards

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1
Q

Pneumonia (etiologies)

A
  • NN: Grp B strep, E coli, Listeria
  • 6wks-18yo: virus, strep pneumo, mycopl, chlam pneumo
  • 18-40yo: mycopl, strep pneumo, virus, chlam pneumo
  • 40-65yo: strep pneumo, haem influ, mycopl, virus
  • Elderly: strep pneumo, haem influ, virus, staph aureus
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2
Q

Pneumonia (PE)

A

Classic: sudden, fever, prod cough, dyspn, pleuritic chest pain
Atypical: gradual, dry cough, headac, myalgia, sore throat

↓ or bronch sounds, rales, wheez, dull to perc, tact fremit
Minim/atyp PE: elder, COPD, DM, immcompr

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3
Q

Pneumonia (dg, complications)

A

Dg: ≥2 symp of acure resp inf + new infilt on CXR/CT
If hospit ptt or refrac outptt: sputum Cx, nasoph aspir, bld Cx, ABG

Complic: pleur effus, empyema, abscess, necrot pneumonia, bacteremia

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4
Q

Pneumonia (ttt)

A

ttt: outptt w/ oral empiric AB if uncomplic
If obstr ds, add pseudo/staph/anaerob coverage

Hopit criteria: CURB-65 (2-3 inptt ttt; >4 admiss)
Confus; Uremia (BUN>19); RR (>30/min); BP (S<90 or D<60); >65yo

Pneumo vacc: all children; >65yo; splenic dysfct, asplen; immcompro; w/chronic ds

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5
Q

Tuberculosis (RF, PE)

A

Latent (asympt) → active (sympt)
Inf lungs/CNS/GU/bone/GI

RF for reactiv: immsuppr; alcoh; lung ds; DM; adv age
Cough, hemoptysis, dyspn, ↓weight, fatigue, night sw, fever, … for >3wks
HIV: atyp sympt and ↑R of extrapulm TB

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6
Q

Tuberculosis (dg)

A

Active: sputum Cx (bld/tissu if extrapulm) #1
Sputum AFS
CXR (cavit in upp lobe); calcif ≥1 LN (Ghon complex)
HIV or 1*TB: low lobe infilt +/- cavit
Miliary: multip fine nod in 2 lungs (hemato/lymph dissem)

Latent: ⊕PPD or QuantiFERON-TB (→ always CXR)
Immcompr w/ latent may be ⊖

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7
Q

Tuberculosis (ttt)

A

Lat+activ: report to local/state health departm
Resp isolat if activ TB

Activ: RIPE x2mo then INH+rifamp x4mo
VitB6 w/ INH
Latent: INH x9mo

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8
Q

Acute pharyngitis (etiologies, PE)

A

Viral (90%): rhino, corona, adeno, EBV, CMV, infl, coxsa, …
Bact: Grp A strep, N gonorr, Coryne diphth, M pneumo

Typical strep: fever, sore thr, eryth, tonsil exudate, LN
Atyp strep: coryza, hoarsn, rhinorr, cough, conjunc, stomatitis, GI sympt

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9
Q

Acute pharyngitis (Dg, ttt, complications)

A

Dg: clinic; GAS Ag; throat Cx
ttt: penicillin x10d if GAS suspect (or cephalo, amoxi, azithro)
Complic:
-Nonsupp: acute rh fever (early AB prevent); PSGN (not prev)
-Supp: lymphadenitis, mastoiditis, sinusitis, …
-Peritonsillar abscess: odynoph, trismus, hot potato voice, uvula deviat, … Intraoral US/CT; ttt AB + surg drain

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10
Q

Sinusitis (etiologies, PE)

A

-Acute: <1mo; virus, S pneumo, H infl, M catarr
Bact rare ass w/ purul disch, tendern, hyposmia, sympt >10d
-Chronic: >3mo; by obstr of sinus drain, low-grade anaerob inf

Fever, facial pain/tendern, headac, congest, discharg

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11
Q

Sinusitis (dg, complications, ttt)

A

Dg: clinic; Cx or radio if chronic/refract
Complic: meningitis, osteomyelitis, cavernous sinus thrombosis, abscess

ttt: acute+viral (self-lim; decong, antihist, saline lavage)
Acute+bact: amoxi/clav x10d (or clarith, azith, TMP-SMX, fluoroq, C2G)
Chronic: AB x3-6wks; intranasal CS, decong, antihist; +/- surg

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12
Q

Coccidioidomycosis (PE)

A

SW USA; pulm fung inf +/- extrapulm
Acut/subacut; incub 1-4wks

Fever, cough, dyspn, night sweats, arthralgias
Dissem (HIV/pgnt/black/filip): meningitis, bone les*, soft T abscess

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13
Q

Coccidioidomycosis (dg, ttt)

A

Dg: serology; PCR of resp; BAL/sput Cx (spherules)
CXR; bronchosc; FN biopsy

ttt: acute (PO flucon/itracon if mild; IV amphoB if sev/dissem)
Chronic: no ttt if asympt; if progr/sympt surgery + azole x8-12mo

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14
Q

Influenza (types, PE)

A

↑contag orthomyxoV; types A/B/C
Ag drift: small gradual chang in surf prot; point mutat
Ag shift: acute major chang in infA; genet reassortment

US: Nov to March; yearly vacc (inact) for all ≥6mo old
Abrupt fever, myalgia, chill, cough, coryza, weak; atyp in elderly (confusion)

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15
Q

Influenza (dg, ttt, complications)

A

Dg: clinic; Ag (nasoph swab); DFA/PCR/Cx
Leukopenia

ttt: analges, cough meds
Oseltam/Zanamiv in 2d of onset (↓inf by 1-3d)
Complic: sev viral pneumonia; 2* bact pneumonia; sinusitis/bronchitis; COPD/asthma exacerb

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16
Q

Meningitis (RF, PE)

A

Acute bact: life-threat emergency
Viral = aseptic, more common, less morbid

RF: ear inf, sinusitis, immdefic, neurosurg, crowded living, sick contact
PE: triad fever, headac, neck stiff
Mal, photoph, alter ment stat, N/V, seiz, Kernig/Brudzinski

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17
Q

Meningitis (etiologies by age)

A
  • 0-6mo: GBS, E.coli/GNRs, Listeria
  • 6mo-6yo: S.pneumo, N.mening, H.influ type b, enteroV
  • 6-60yo: N.mening (#1 teen), S.pneumo, enteroV, HSV
  • > 60yo: S.pneumo, GNRs, Listeria, N.mening
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18
Q

Meningitis (dg)

A

Dg: LP (CSF Gram+Cx); gluc/prot/WBC+diff/RBC/opening pressure; !!! if no papilledema or focal neuro deficit
Viral PCR; crypto Ag if HIV
CT or MRI: if alt ment stat, papilled, focal neuro def → exclude mass or ↑ICP
Bld Cx, CBC

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19
Q

Meningitis (management, complications)

A

AB rapidly + empirically before LP
! AB started before CT
Some viral: support + follow-up
Close contact if N.mening: rifampine or ciprofloxacine

Complic: sensorineur ↓hearing; mental impair; seiz; cereb edema; ↑ICP; empyema; abscess; hydroceph +/- inf; focal neuro def; coma; death

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20
Q

Meningitis (ttt)

A

Dexameth in S pneumo: 15min before AB; ↓morta, ↓short-term neuro complic
If immcompr, elder, NN: add ampicillin (Listeria)

  • <1mo: ampicill + cefotax or gentam
  • 1mo-adult: vancom IV + ceftriax or cefotax
  • > 60yo/alcoh/chron ds: ampicill + vancom + cefotax or ceftriax
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21
Q

Encephalitis (PE, #dg)

A

Esp HSV and arboviruses
Rare: CMV, toxopl, West Nile V, VZV, Borrelia, …
Esp child and elder

Alter consc, headac, fever, seiz
Letharg, confus*, coma, focal neuro def
#dg: abscess, malign, toxic/metab encephalop, hematoma, hge
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22
Q

Encephalitis (dg, ttt)

A

CSF: ↑lymphoc, ↑prot, ↓glu in TB/fung/bact/amebic
LP: cells, glu, prot, Cx, Gram, AFS, India ink, PCR, serology
CT or MRI: HSV in temporal lobe

ttt: HSV immediate IV acyclovir (! ↑morbi)
CMV: IV ganciclovir +/- foscarnet
Doxycycline if susp RMSF/ehrlich
Lyme: ceftriaxone

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23
Q

Brain abscess (etiologies)

A

Esp strepto, staph, anaerob; polymicrob
Immsuppr: toxopl, candida, asperg, zygomyc
Epidemio: neurocysticercosis

Direct spread: sinusitis, otitis med, mastoiditis, dental inf
Direct inoculation: head trauma, neurosurg
Hemato spread: middle cereb art distribution w/ multiple absc at gray-white junction

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24
Q

Brain abscess (PE, dg, #dg)

A

dg: if no fever, susp 1* or meta brain tumor

Early: fever, headac (dull/constt/refract), inattent, confus, seizures → ↑ICP (CN III+VI def) → signs of focal neuro def

Dg: CT (ring enhanc); MRI (if early or post fossa)
No LP (!!! herniation); ↑ESR/↑CRP
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25
Q

Brain abscess (ttt)

A

Broad IV AB + surg drain (dg +/- ttt); IV mannitol (↓ICP)
If <2cm, just medical ttt
C3G + metronid +/- vancom
IV for 6-8wks and follow w/ serial CT/MRI
If severe, dexameth (↓cereb edema)
Prophyl anticonvulsant

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26
Q

HIV (PE)

A
  • CD4+ count: degree of immsuppr; guides ttt/prophyl; determ complic + pg
  • Viral load: predict rate of progr; indicat* ttt; resp to ART

Acute inf: dys-wks aft expo; asympt or flu-like
Later: night swt, ↓weight, thrush, recurr inf, opport inf

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27
Q

HIV (dg)

A
  • ELISA: detect Ab (up to 6mo to ⊕)
  • Western blot: to confirm
  • Rapid HIV tests
  • Baseline: RNA PCR (vir load), CD4+ count, PPD or IGRA, Pap smear, VDRL/RPR, serol CMV, viral hepat, toxo, VZV
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28
Q

Common AIDS-defining illnesses

A 
Esoph candidiasis
CMV retinitis
Kaposi sarcoma (HHV-8)
CNS lymphoma; toxoplasmosis; PML
P jirovecii or recurrent bacterial pneumonia
HIV encephalopathy
Disseminated mycobacterial or fungal infection
Invasive cervical cancer
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29
Q

HIV (ttt)

A

-ART: all ptts, regardless of sympt or CD4+ count; lifelong
2 NRTIs + 1 NNRTI or protease inhib or integrase inhib
- HIV genotype before ttt and when resistance
-Monthly monitor CD4+ and viral load until suppression (<50 copies) then every 3-6months
-Prophyl ag opportun inf

-Prophylaxis when expo to HIV: ≥2 ART asap x4wks; dep on severity of source inf

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30
Q

HIV (prophylaxis against opportunistic infections)

A
  • CD4 >200: MMR and varicella vaccines
  • <200: P.jirov; TMP-SMX
  • <50-100: MAC; azithro/wk
  • <100: toxo; TMP-SMX
  • PPD>5mm or ↑R: INH x9mo (+B6) or rifampin x4mo
  • Multiple recurr: candida (esoph: flucon; oral: flucon or nystatin); HSV (acyclo/valacyclo/famcyclo daily)
  • All ptts: S pneumo (pneumovax /5y); influenza (vaccine/y)
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31
Q

Oropharyngeal candidiasis / Thrush

A

RF: xerostomia, AB use, denture, immsuppr
Soft white scrapab plaq, erythem base, odynoph
#dg: oral hairy leukopl

Dg: clinic; KOH or Gram (budd yeast +/- pseudohyph)
ttt: thrush (nystatin susp, clotrimaz PO, flucon PO)
Esoph (PO azole)

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32
Q

Cryptococcal meningitis

A

RF: AIDS, expo to pigeon dropp
Headac, fever, ↑ICP, impair ment, !!No mening signs
#dg: toxo, lymphoma, TB mening, AIDS dementia, PML, HSV enceph, other fung

Dg: LP, crypto Ag (CSF or bld), CSF india ink, fung Cx
ttt: IV amphotB + flucytosine x2wks then flucon x8wks
Lifelong flucon until asympt + CD4>100 for >1y

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33
Q

Histoplasmosis (RF, PE, #dg)

A

dg: atyp bact pneumonia, blastom, coccidio, TB, sarcoid, pneumoconiosis, lymphoma

RF: HIV/AIDS, spelunk, expo bat excr; Ohio/Mississipi RV
1* expo: asympt or flulike to pulm+/-extrapulm manif
Dissem: fev, ↓weight, HSMG, LNpathy, cough, pancytop

34
Q

Histoplasmosis (dg, ttt)

A

Dg: CXR; urine+serum polysaccharide Ag; Cx (bld, sputume, CSF); biopsy or BAL w/ special stain; monitor response to ttt/relapse

ttt: mild pulm ds (itracon); chronic cavit (itracon >1y); severe acute pulm or dissem (liposomal amphotB x2wks then itracon ≥1y)

35
Q

Pneumocystis jirovecii pneumonia

A

RF: impaired cell imm; AIDS
Dyspn on exert*, fev, nonprod cough, tachypn, impair O2, ↓weight, fatig; +/- dissem
#dg: TB, histop, coccidio

Dg: cytology (sputum/BAL) w/silver stain; ABG (PaO2); CXR
ttt: high-dose TMP-SMX x21d; prednisone if mod-sev hypox

36
Q

CMV (RF, PE)

A

70% of adults in US; most asympt
By sex, vertical, breast milk, resp dropl, bld transfu
RF for reactiv: 100d s/p transpl; HIV/AIDS (CD4<100 or viral >10K)

Mono-like; retinitis (detach); GI+hepatobil (pain/bleed/ cholangiopathy); pneumonitis (↑morta); CNS (polyradic/
myelitis/subacte enceph)

37
Q

CMV (dg, ttt)

A

Dg: Cx, tissu histopath, serum PCR

ttt: ganciclovir, valganciclovir, foscarnet

38
Q

Mycobacterium avium complex (PE, prevention)

A

1* inf: pulm; in apparent healthy nonsmoker
2* inf: pulm; in ptt w/ preexist pulm ds (COPD/TB/CF)

Dissem: AIDS w/ CD4<50; in ptt Not on HAART or proph for MAC; fever/weak/↓weight
Prevent: azithro/wk for CD4<50 or AIDS-def opport inf

39
Q

Mycobacterium avium complex (dg, ttt)

A

Dg: mycobact bld Cx (⊕ in 2-3wks)
Anem, hypoalb, ↑ALP, ↑LDH
Biopsy (BM/liv/intest): foamy macroph w/ A-F bacilli

ttt: clarithrom (#1); ethambutol+/-rifabutin (#2)
>12mo and until CD4>100 for >6mo

40
Q

Toxoplasmosis (RF, PE, dg)

A

RF: raw/underck meat; cat litter
1* inf: asympt
Reactiv: immcompr (brain/lung/eye > others)

Dg: serology, PCR; histo or tissu Cx
If CNS involv, CT (multiple iso/hypodense ring-enhanc) or MRI (basal gg)

41
Q

Toxoplasmosis (ttt, prophylaxis)

A

High-dose PO pyrimethamine + sulfadiazine and leucovorin x4-8wks
Then low-dose until resolut* (clinic+radio)

Prophyl if CD4<100 w/ ⊕IgG: TMP-SMX or pyrimethamine+dapsone

42
Q

Chlamydia (RF, #dg, complications)

A 
#1 STD in US
RF: unprotect sex; new or multiple partners
LGV serovars: lymphogranuloma venereum
#dg: gonorr, endometriosis, orchitis, vaginitis, UTI
Complic: chron inf/pelv pain; Reiter sd (ureth, arthr, conjunct); Fitz-H-C sd; ectopic pgncy; epididymitis
43
Q

Chlamydia (PE)

A

Asympt in men; penile disch or testic tenderness
Urethritis, mucopur cervicitis, PID; cervical/adnexal tenderness in women
Other: arthritis, neonat conjunctivitis, pneumonia

LGV: 1* painless papul/ulcer; 2* painful swell ing LN; 3* anogenital sd

44
Q

Chlamydia (dg, ttt)

A

Dg: Cx (#1); urine NAAT (rapid); Gram of discharge (PMNs but no bact bcz intracell)

ttt: doxycycline x7d or azithrom once (azithr or amoxi in pgnt); ttt partner; ! ttt gonor
LGV ttt x21d

45
Q

Gonorrhea (PE, #dg, complications)

A

W: green/yellow disch; pelv/adnex pain; swoll Bartolin
M: purul urethr disch; dysuria; eryth of meatus

#dg: chlam, endometriosis, pharyngitis, vaginitis, UTI, salpingitis, tubo-ovar abscess
Complic: persist inf/pain; infertil; abscess+rupture; dissem (migrat polyarth, tenosynov, pustul skin)
46
Q

Gonorrhea (dg, ttt)

A

Dg: Gram+Cx (#1); NAAT (genit tissu, urine)
Dissem: monoartic septic arthritis; rash; tenosynovitis

ttt: ceftriax IM and azithrom PO
Condoms (prophyl); ttt partner
Dissem: IV ceftriax ≥24h

47
Q

Syphilis (3 phases)

A

1* (10-90d): painless ulcer (chancre)
2* (4-8wks): low-gr fever, headac, mal, LNpathy, symm maculopap rash palm/sole (nonprur); condyloma lata
-Early: <1st y; asympt; ⊕ serology
-Late: >1y; asympt; ⊕or⊖ serology; 1/3 prog to 3*
3* (1-20y): gummas, neurosyph (tabes dorsalis, meningitis, Argyll Robertson pupil), cardiovasc (aortitis, Ao root aneurysm, Ao regurg)

48
Q

Syphilis (dg, ttt)

A

Dg: VDRL (false⊕ w/ virus, drugs, IVDA, RF, RA, SLE, leprosy)
Neurosyph: in AIDS w/ neuro sympt + ⊕RPR test

ttt: 1/2 (benzathine penicillin IM once); tetracyc/doxyc x14d if peni all
Latent (benzathine peni)
Neurosy: peni IV x10-14d
! Jarisch-Herxheimer: flulike after ttt (endotox release)

49
Q

Urinary tract infections (etiologies, RF)

A

E coli; serrat; enterobact; klebs pneumo; staph saproph; pseudom; proteus mirab

RF: catheter, instrum, anatom abNl, previous UTI/pyeloneph, DM, recent AB, immsuppr, pgncy

50
Q

Urinary tract infections (PE, #dg)

A

dg: vaginitis, STDs, urethritis, prostatitis

Dysuria, urgency, fqcy, suprapub pain, hematur
Child: bedwett, poor feed, …
Elder: delirium, acute confus*

51
Q

Urinary tract infections (dg)

A

Dg: clinic; UA (↑leukoc esterase, ↑nitrites); microsc (pyuria >5WBCs, bacteriuria 10^6); Cx (>10^5)

If asympt just ttt child/anatom abNl/pgnt W/instrument/surg/renal transpl

52
Q

Urinary tract infections (ttt)

A
  • Uncompl: outptt, PO TMP-SMX x3d, fluoroq x3d, nitrofur x5d
  • Compl (obstr/men/renal transp/cath/instrum): same AB x7-14d
  • Pgnt W: nitrofur, cephalosp, amoxic x3-7d (No fluoroq, TMP-SMX, tetracyc) even asympt
  • Urosepsis: hospit + IV AB (broad cover to include resist GNRs/enterococ)
  • Prophyl for W w/ recurr uncompl UTIs
53
Q

Pyelonephritis (etiologies, RF, PE, dg)

A

Same etiologies + RF as cystitis
Same signs + symptoms as cystitis w/ flank pain, fev/chill, N/V

Dg: UA (w/ WBC casts); Cx; CBC (↑WBCs); if no resp to ttt in 48-72h do US/CT (obstr/abscess/complic)

54
Q

Pyelonephritis (ttt)

A

Mild: outptt; fluoroq x7-14d; ↑fluids+monitor

Severe/complic/pgnt/susp bacteremia: hospit; IV AB (fluoroq, C3G, C4G, Beta-lactam+B-lactamase inh, carbap)

55
Q

Sepsis (etiologies)

A

SIRS (≥2): temp (<36;>38); RR (>20; PaCO2<32); HR (>90); WBCs (<4K; >12K; >10% band)
Sepsis: SIRS + docum inf
Severe sepsis: w/ end-org dysfct from poor perf
Sepsis shock: w/ hypoTN + org dysfct from vasodil

Gram⊕shock: 2/2 fluid loss by exotoxins
Gram⊖shock: 2/2 vasodilation by endotoxins

56
Q

Sepsis (PE, dg, ttt)

A

Abrupt fever/chill; alt ment stat; tachycard; tachypn
+/- end org dysfct; hypoTN
Sep shock: warm extr

Dg: clinic; ↑/↓WBCs; ↓plts; ↓tissu perf; abNl coag
!!! Cx of all approp sites; CXR/CT
ttt: ICU; aggr IV fluids; emp AB; vasopress; underl cause; !!! maintain BP + org perfusion

57
Q

Malaria (PE, complications)

A

P.falciparum highest morbi/morta
Chemoproph + mosq repellent befor travel endemic

Hx of travel (even after mo/ys) + periodic chill/fever (>41) + diaphoresis (4-6h)
SMG ≥4d after
Asympt betw/ attacks; attacks every 2-3d

Complic: cerebral malar; sev hemolyt An; renal; pulm edem; lactic acidosis; …

58
Q

Malaria (dg, ttt)

A

Dg: species; Giemsa/Wright thin/thick bld films; normoch normocyt An w/ reticulocyt

ttt: uncompl inf (chloroquine PO)
P. vivax/ovale: chloroquine + primaquine
Severe: IV quinidine then PO
Prophyl to chlor-resist sp: atovaquone-proguanil and mefloquine

59
Q

Infectious mononucleosis (PE, #dg)

A

dg: strep phar; CMV; toxo; HIV; HHV-6

Acute EBV; body fluids
Fev + pharyngitis; fatig; LNpathy (post cerv); SMG; bilat upper eyelid edema; sympt after 2-5wks

60
Q

Infectious mononucleosis (dg, ttt)

A

Dg: Monospot; EBV-specif Ab. If both ⊖ then CMV
Mild ↓plts; ↑lymphoc (atypic T lymphoc)

ttt: support; CS if airway comprom (tonsill enlarg)
! Ampicillin gives prolong/prurit maculopap rash

61
Q

Infectious mononucleosis (complications)

A
  • CNS inf: asept meningitis; encephalitis; CN palsy; …
  • Splenic rupt: esp men, abdo pain then left should
  • Upper airway obstr: ttt w/ steroids
  • Bacterial superinf: 2* strep phar
  • Fulminant hepatic necrosis: esp men, #1 death cause
  • Autoimmune hemolytic anemia: rare, Coombs⊕, ttt w/ CS if severe
62
Q

Fever of unknown origin (PE, etiologies, dg, ttt)

A

> 38.3 for ≥3wks w/o dg after 3 outpt or 3 hospit
+ headac, myalg, malaise
Causes: esp inf + cancer; then autoimm ds

Dg: Hx (fam/social/sex/occup/diet/expo/travel); CBC w/ diff; ESR; serum prot electroph; Cx from everyw/; PPD; specif tests (ANA, …); CXR/CT TAP; colono; …
ttt: Stop unnecessary meds

63
Q

Fever of unknown origin (#dg)

A
  • Inf: TB, endocarditis (HACEK), abscess, osteomyelitis, cath inf; if HIV then MAC/histopl/CMV
  • Neopl: lymphoma, leuk, hep or renal cell carcin
  • Autoimm: Still, SLE, cryoglob, PAN, connect tiss ds, granulomatous ds
  • Miscell: PE/DVT, IBD, alcoh hepatitis, drug, FMF, factitious
  • Idiop (10-15%)
64
Q

Neutropenic fever

A

1 episode ≥38.3 or ≥38 for ≥1h + neutrop (ANC<500)
Esp cancer ptt w/ chemot (esp 7-10d s/p chemot)

Dg: detailed PE but No DRE (bleed); CBC w/ diff; creat; BUN; transam; Cx from everyw/; test V/B/F; CXR; CT
ttt: empir IV AB w/ antipseudom (cefepime or pip-tazo)
If fever persist >72h, start antifungal

65
Q

Ehrlichiosis

A 
Lone star tick
Endemic to S-central + SE of US
Headac, fev, chill, alt ment stat, myalg
Leukopenia, thrombocytopenia, ↑liv enz
ttt: doxycycline
66
Q

Lyme disease (PE)

A

Spirochete Borrelia burgdorferi; Ixodes tick
Esp summer; endemic to NE of US
Rash + fev, mal, fatig, headac, myalg/arthralg

1* (local): erythema migrans
2* (early dissem): migrat polyarthrop, neuro (Bell palsy), meningitis, myocarditis, conduc abNl (3* block)
3* (late): arthritis, subacute encephalitis

67
Q

Lyme disease (dg, ttt)

A

Dg: early (clinic, Hx); dissem/late (clinic, Hx, serolog)
Serol tests just when: endemic + expo RF + sympt (dissem/late). If ⊕/UNK, ELISA IgM/IgG the Western blot

ttt: early (doxycy)(amoxic if <8y or pgnt); advanc (ceftriax)
Prophyl: avoid ticks in endem; 1dose doxycy if 4 criteria met. If not, observe and ttt when erythema migrans

68
Q

Rocky mountain spotted fever

A

Rickettsia rickettsii; Dermacentor tick
Invade endoth of capill → small Vx vasculitis
Headac, fev, mal, rash (macular on wrists+ankles then petech/purpura spread centrally)

Dg: clinic + confirm w/ biopsy + indir ImmFluor
ttt: doxycyc or chloramph (if pgnt); fatal if unttt
Prevent tick bite

69
Q

Infectious conjunctivitis (common causes)

A

-Staph/Strep/Haemo/Pseudo/Morax: purul disch; Gram/Cx if sev; AB drop/ointm
-N.gonorr: Emergency! (!blind); Gram; IM/IV ceftriax
-C.trachom A-C: neonat; mucopurul; Giemsa/Cx; Azithro/tetrac/erythro x3-4wks (NN)
Trachoma: recurr keratitis; !!prevent; 1dose PO
-AdenoV: watery disch; LNpathy; contagi (epidem); topical CS w/ follow-up

70
Q

Orbital cellulitis

A

Strep, staph, H.influ; mucor/rhizopus (immcompro/DM)
Acute fev, proptosis, ↓extraoc mvt, pain, ↓vis acuity
Hx of ocul trauma/surg; sinusitis

Dg: clinic; bld/tissu Cx; CT (!abscess)
ttt: admit, IV AB, Opht/ENT consult; +/- surg
Immcompro/DM: amphoB + surg debri
Complic: endophthalmitis, blind; caver sinus thromb

71
Q

Otitis externa

A

Pseudom, enterobacteriaceae; excess moisture
Pain (+ w/ mvt tragus/pinna), prurit, purul disch, edema, erythema
Dg: clinic; Cx if sev/refr; CT if ptt toxic

ttt: clean + AB drop (oflox/ciprof) + steroid drop
Immdef/DM/Sev: !necrotizing OE: IV AB (fluoroq/C3G/C4G + aminogly)

72
Q

Infective endocarditis (RF, etiologies)

A 
Esp valves (esp MV)
RF: rheum, congen, valvul ds, prosthetic V, IVDA, immsupp
  • S aureus: >80% of acute IE; IVDA; prosthetic V
  • Viridans strep: #1 left subacute IE; dental proc; native V
  • Coag⊖ staph (epiderm): #1 IE in prosthetic V
  • Strep bovis: GI malign
  • Candida/Asperg: long-term IV cath; malign; AIDS; org transpl; IVDA
73
Q

Infective endocarditis (Cx ⊖)

A 
H: Haemo parainflu
A: Actinobacillus
C: Cardiobacterium
E: Eikenella
K: Kingella
Coxiella/Brucella/Bartonella
74
Q

Infective endocarditis (PE)

A 
Fev/FUO, ↓weight, fatig
Murmur (MV>AV; in IVDA TV>MV>AV)
Osler nodes: small tender, finger/toe
Janeway les*: small periph hge
Splinter hge: subungual petech
Roth spots: retinal hge
Focal neuro def (embolic stroke); other emboli
75
Q

Infective endocarditis (dg)

A

Serial bld Cx from diff sites
Duke criteria (2Maj; 1Maj+3min; 5min)
-Major: ≥2⊕ bld Cx w/ typic org OR persist bacteremia w/ any org OR 1⊕bld Cx coxiella
-Major: ⊕ TEE OR new murmur
-minor: predisp RF
-minor: fever ≥38.3
-minor: vascular phen (septic emboli/infarct; mycotic aneurysm; Janeway les*)
-minor: immuno phen (glomeruloneph; Osler; Roth)
-minor: microb evidence #major

76
Q

Infective endocarditis (ttt)

A

Early empir IV AB (vanco + genta)
Change AB once ⊕Cx
! Acute V replac sometimes

Pre-proced prophyl: amoxicillin (clinda/azithr/clarith)
ONLY if ptt w/ signif card defect (prosth V, unrepaired congen, prior Hx IE, transpl heart) AND high-risk proced (dental+gingival, mucos perfor (mouth/respir), GI/GU surg w/ recurr GI/GU inf)

77
Q

Anthrax (RF, PE)

A

Animal wool/hair/hides/bone meal prod; biol weapon
No person-to-person

Cutaneous (#1): 1-7d after skin expo; prurit papul → ulcer → black eschar; LNpathy
Inhalation (#1 morta): fev, dyspn, hypox, cough, hgic mediastinitis
GI: undercook contam meat; dysph, N/V, bld diarr, abdo pain

78
Q

Anthrax (dg, ttt)

A

Dg: 1⊕Cx or 2 nonCx (PCR/immhistochem/ELISA)
CXR (wide mediast; pleur eff)

ttt: ciproflox or doxyxy + 1-2 AB
Inh or cut face/neck: ≥14d
Cut (other): 7-10d
Postexpo prophyl: ciproflox x60d

79
Q

Osteomyelitis (etiologies)

A

Bone or BM; direct spread (80%; adult); hemato (20%; child/metaphyse; IVDA/vertebral)

  • No RF: S aureus
  • IVDA: S aureus, pseudo
  • SCD: salmonella
  • Hip repl: S epiderm
  • Chronic: S aureus, pseudo, enterobacteriaceae
  • DM: polymicr, pseudo, S aureus, strep, anaerob
80
Q

Osteomyelitis (PE, dg)

A

Local bone pain, tendern, warmth, swell, limit motion
Fev/chill, purul disch

Dg: ↑WBCs/ESR/CRP; bld Cx; Xray (first ⊖ then 10-14d periost elevat)
MRI (#1); bone aspirat w/ Gram/Cx (defin)

81
Q

Osteomyelitis (ttt, complications)

A

ttt: surg debrid then IV AB x4-6wks
Clindam + Ciproflox or ampic/sulbactam or oxacill/nafcill (MSSA); vanco (MRSA); ceftriax or ciproflox (G⊖)

Complic: chron osteomy; sepsis; septic arthritis
Marjolin ulcer = chron osteom w/ draining tract leading to SCC

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