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Internal Medicine > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

SIRS criteria

A
  • Temperature >38 or <36
  • Tachycardia
  • Respiratory rate over 20 or PCO2 under 32
  • WBC over 12 or under 4
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2
Q

Organs in dysfunction in sepsis

A

Hypotension, AMS, increased creatinine, LFTs

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3
Q

Therapy goals for sepsis?

A

Goal directed therapy

  • CVP 10-12 mm Hg
  • MAP >65 mmHg
  • U output of 0.5 cc/kg/hr
  • SvcO2 over 70
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4
Q

What are the therapy actions needed to correct sepsis?

A
  • Blood cultures should be drawn prior to sepsis
  • Eliminate source of sepsis
  • 30cc/kg bolus fluid challenge
  • If fail fluid challenge - need pressors
  • Maintian oxygenation as needed
  • Empiric abx while waiting for cultures
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5
Q

Want to treat anaerobes?

A

Depends on location of bugs

  • Gut and vagina: metro
  • Everywhere else: Clindamycin
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6
Q

Staph infection? MRSA? UTI?

A
  • Staph: Nafcillin
  • MRSA: Vanc
  • UTI: Ampicillin or ciprofloxycin (Flagyl)
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7
Q

Generations of quinolone and coverages

A
  • 1st gen - ciprofloxacin: gram negative (UTI) only
  • 2nd gen - levo: gram negative coverage
  • 3rd gen - moxi: gram negative and positive
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8
Q

Penicillin allergy alternatives

A

If rash: Cephalosporins

If anyphylaxis: DONT go cephalosporin

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9
Q

Pseudomonas coverage

A

Pip/tazo (zosyn), carbapenems, cefepime

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10
Q

Outpatient pneumonia treatment

A

Doxycycline, azithryomycin moxifloxacin

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11
Q

Inpatient pneumonia drugs

A
  • 3rd gen cephalosporins + azithromycin for CAP
  • Vanc + Zosyn (pip/tazo) for HAP
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12
Q

Neutropenic fever drugs

A
  • 4th gen cephalosporin (cefepime)
  • Carbapenems
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13
Q

UTI drugs

A

TMP-SMX, nitrofurantoin

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14
Q

Meningitis treatment

A

Vanc, ceftriaxone +/- steroids, +/- ampicillin

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15
Q

Cellulitis drugs

A

Cefazolin, bactrim, clindamycin, IV Vancomycin

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16
Q

CENTOR criteria

A

CENTOR

  • Absent Cough
  • Exudates
  • Nodes
  • Temp (fever)
  • OR - young = +1 and old = -1
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17
Q

Strep bovis origin? What does it cause?

A

Bovis comes from the colon and can cause endocarditis

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18
Q

Staph aureus origin and what can it cause in the heart?

A

IVDA cause tricuspid valve vegetations from skin flora

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19
Q

Oral flora?

A

Strep everything

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20
Q

Dukes criteria

A

Criteria for infective endocarditis

  • Major
    • Sustained bacteremia by organism known to cause IE
    • Endocardial evidence by Echo
    • New valvular regurgitation
  • Minor
    • Predisposing risk factors
    • Fever > 38
    • Vascular Phenomena
    • Immunologic phenomena
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21
Q

Which organisms cause acute endocarditis?

A

Staph, strep pneumo which infect normal native valves

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22
Q

What is the presentation of acute endocarditis? How is this diagnosed?

A
  • New murmur in a patient who is sic with persistent bacteremia leading to valve destruction.
  • Diagnose with a unch of cultures to watch for clearance and start antibiotics right away
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23
Q

What is the presentation of subacute endocarditis?

A
  • Roth spots in the eyes
  • Janeway lesions (painless hands)
  • Splinter Hemorrhages (Nailbeds)
  • Osler nodes (Painful distal digit pulp)
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24
Q

How is infective endocarditis diagnosed?

A
  • Acute: Keep getting cultures until bacteremia clears but then get a TEE
  • Subacute endocarditis: Get a culture when you notice lesions. Bacteremia? Get a TEE
25
Q

How long is infective endocarditis treated?

A

6 weeks

26
Q

How is infective endocarditis treated with antibiotics in a native valve?

A

Vanc

27
Q

What is the antibiotic regimen for prosthetic valves?

A
  • <60 days: Vanc, gent, cefepime
  • 60-365: Vanc, gent
  • Over 365: Vanc, gent, ceftriaxone
28
Q

When does an endocarditis valve need to go to surgery?

A
  • >15 mm without embolization
  • >10 mm + embolization
  • Abscess
  • Valve destruction or CHF
  • Fungus
29
Q

What are the prophylaxis measures for a bad valve?

A

Congenital heart disease, prosthetic valve, history of endocarditis?

  • Amoxiciillin
  • Cefazolin
  • Clindamycin
30
Q

What are the prophylaxis measures for a dental procedure?

A

Amoxicicillin

Cefazolin

Clindamycin

31
Q

Treatment for urethritis

A
  • Ceftriaxone + Doxy or Azithromycin
32
Q

What is the treatment for cystitis?

A

TMP-SMX or Nitrofurantoin or fosfomycin

33
Q

What is the treatment for pyelo

A

IV cephalosporin if inpatient or PO fluoroquinolones outpatient

34
Q

What is the treatment for a urinary tract abscess

A

Drain it and use IV cephalosporin inpatient or PO FQ outpatient

35
Q

What do you do after treating someone who is pregnant with a UTI?

A

Confirmation of eradication by urine cultures

36
Q

Treatment difference between complicated and uncomplicated urethritis

A

Uncomplicated? 3 days. Complicated? 7 days

37
Q

What is the treamtent for cellulitis?

A

Group A strep and Staph aureus infection, so use first gen cephalosporin or antibiotics that cover MRSA like bactrim or clindamycin

38
Q

What causes you to suspect meningitis? What do you do after?

A
  • Check for fever and headache
  • Blood cultures, Antibiotics and Lumbar puncture
39
Q

What LP findings show bacterial meningitits? What do you do after you find this?

A
  • Increased cell count with tons of neutrophils
  • Decreased glucose
  • Increased protein
  • Tx: Ceftriaxone, vanc, steroids and ampicililn if immunocompromised
40
Q

What will make you think encephalitis and not meningitis?

A

Fever, headache and confusion

41
Q

What should be considered before doing an LP?

A

FAILS menmonic

  • F: Focal neurological deficits
  • A: AMS
  • I: Immunocompromised
  • L: Lesion
  • S: Seizures
42
Q

How is the definitive diagnosis of HSV made?

A

PCR

43
Q

What should clue you in to an abscess vs cancer?

A

Brain biopsy is needed and will show organisms in an abscess requiring drainage or cancer requiring radiation and chemo

44
Q

Presentation of syphilis and test to confirm?

A
  • Presentation: Painless firm ulcer with lymphadenopathy
  • Test:
    • Primary: Dark field
    • Secondary: RPR
    • Tertiary: LP
45
Q

Presentation and tests for Ducreyi?

A

Painful singular ulcer with lymphadenopathy. Gram stain and culture

46
Q

What is the presentation and test for LGV?

A

Painless singular ulcer that requires no test

47
Q

What is the presentation and test to confirm herpes?

A

Roofed painful vesicles with an erythematous base tested with HSV PCR

48
Q

2+1 treatment for HIV

A

2NRT-I and 1 of the following…

  • 1 NNRTI
  • 1 PI/r
  • 1 Integrase inhibitor
  • 1 Fusion inhibitor
49
Q

What drugs are in PrEP? PEP? What HIV drug do you use in pregnancy?

A
  • PrEP: Emtricitabine and tenofovir
  • PEP: EMtricitabine and tenofovir +/- Raltregravir
  • Pregnancy: AZT at the time of delivery
50
Q

Define AIDS

A

CD4 under 200 or the presence of an opportunistic infection

51
Q

When do you have to prophylax for PCP pneumonia and what do you do?

A

1st bactrim then dapsone (if allergic to bactrim) then atovaquone (if G6PD deficient) at CD4 level 200

52
Q

When do you prophylax for toxo and what do you do?

A

Bactrim and pyrimethamine at under 100

53
Q

When do you prophylax for MAC?

A

Azithromycin at CD4 under 50

54
Q

What are the RIPE side effects?

A
  • R: Red Urine
  • I: Neuropathy
  • P: Hyperuricemia and gout
  • E: Eye disturbance
55
Q

What is the presentation of tuberculosis

A

Night sweats, fever, weight loss, hemoptysis and cough

56
Q

What is the diagnostic process of tuberculosis?

A
  • Asymptomatic screen performed on people who arent symptomatic but require proof of their absence of exposure
  • If positive exposure then do chest xray
    • If this is positive then the person is infected and need an AFB Smear
      • If positive then active infection and ripe
      • If negative then INH + B6 x 9 months
    • If negative then INH + B6 x 9 months
57
Q

What are the cutoffs for + PPD screening

A
  • 5 mm (immunosuppressed)
    • HIV, organ transplant, steroids, TB
  • 10 mm “exposed”
    • Incarcerated
    • Healthcare provider
    • Endemic areas
  • 15 mm “not exposed”
58
Q
A

Internal Medicine (7 decks)

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