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MTBs Step 3 > 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
causes of bloody diarrhea
campylobacter, salmonella, vibrio, e.Coli, shigella, yersinia, amebic
26
What is the best initial treatment for severe diarrhea(blood, fever, abdominal pain, hypotension, tacycardia) if you dnt know the cause?
FQ like ciprofloxacin
27
sx of acute heptatitis
jaundice, fatigue, weight loss, dark urine caused by increased bilirubin in urine
28
which type of hepatitis can be deadly in pregnant women?
hepatitis E
29
which is elevated more AST or ALT in hepatitis/
ALT > AST
30
you will see osteomyelitis most commonly in patients with...
DM, PAD, or ulcer or soft tissue infection
31
what is the best initial test for OM? 2nd test? most accurate?
Xray > MRI > bone bx
32
what is the MC mechanism of spread of infection to bone?
OM caused by direct contiguous spread from teh overlying tissue to the bone.
33
MCC of osteomyelitis?
staphylococcus
34
tx of osteomyelitis?
4-6 weeks with vancomycin + pip/tazo untill cultures return
35
tx of otitis externa?
topical abx(ofloxacin, ciprofloxacin) + topical hydrocortisone to decrease swelling
36
tx of otitis media
augmentin or cefdinir
37
tx of sinusitis?
augmentin
38
Tx of urethritis &/or Cervicitis
Ceftriazone IM + Azithromycin 1x and then Doxy for 7days
39
Tx of Urethritis &/or Cervicitis in prego?
Ceftriazone IM + Azithromycin *no doxy bc can mess with baby bones + teeth
40
outpatient treatment for PID
Ceftriaxone IM and Doxy oral or cefoxatine
41
inpatient treatment for PID
Cefoxitin or Cefotetan IV and doxy
42
what drugs are safe in prego?
PCNs, Cephalosporin, Aztreonam, Erythromycin, Azithromycin
43
PID sx? dx?
lower abdominal pain, tenderness, fever, cervical motion tenderness**, leukocytosis 1. PREGO tests 2. cervical culture and NAAT test
44
sx of Epididymo-Orchitis
painful and tender testicle with a *normal position in the scrotum *different from torsion bc torsion would be elevated and horizontal position
45
tx of Epididymo-Orchitis
<35yoa = Ceftriaxone and doxy | >35 yoa = FQ
46
Chancroid v syphilis v lymphogranuloma venereum v HSV ulcers sx?
``` Chancriod = painful ulcers Syphilis = painless ulcers Lymph = painful LYMPH HSV = painless lymph + painful ulcer ```
47
Tx of Chancroid?
PO azithromycin 1x OR IM ceftriaxone
48
Tx of Lymphogranuloma venereum?
Aspirate the bubo then doxy or azith *remember this is chlamydia trachomatis
49
tx of HSV ulcers? | what if resistant?
acyclovir! resistant do ganciclovir
50
tx of syphillis ulcers?
IM PCN
51
what is a Jarisch-Herxheimer Reaction?
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
What is Argyll-Robertson Pupil?
eyes accommodate to objects but do not respond to light.
53
What is Tabes Dorsalis?
loss of position and vibratory sense, incontinence and CN abnormalites due to syphilis involving the posterior colums
54
BIG BEEFY ulcer on genital/perineum? dx?
Granuloma Inguinale = Klebsiella Granulomatis *this is BIG & BEEFY
55
tx of Granuloma Inguinale
Doxy, TMP/SMX or Azith
56
sx of Pediculosis?
aka CRABS | larger than scabies, in hair-bearing areas such as the pubic or axilla, visible on the surface
57
tx of Pediculosis
Permethrin > Lindane
58
Sx of Scabies
smalle, burrows in webs of fingers, scrape and magnify
59
tx of Scabies
Permethrin > Lindane | *same as pediculosis
60
how do you dx warts?
BY HOW THEY LOOK! you ndt need to bx a wart! regardless of what caused it (HPV, Molluscum, etc)
61
tx for warts
cryotherapy, laser removal, melting with trichloroacetic acid
62
how do you treat widespread scabies(like total body scabies)
Ivermectin
63
sx of cystitis? MCC?
urinary frequency, urgency, burning, and dysuria MCC = E.Coli
64
tx of uncomplicated cystitis? what if its resistant?
tx Fosfomycin or Nitrofurantoin PO 3d resistant: Ciprofloxacin or Levofloxacin
65
tx of complicated cystitis?
7d TMP/SMX or ciprofloxacin
66
how do you dx cystitis?
U/S >>Culture *if you highly suspect cystitis = go ahead and initiate tx. you can change later if resistant
67
tx of pyelonephritis?
ciprofloxacin inpatient: ciprofloxacin, ampicillin + gentamicin =these are all excreted in high concentration in urine =)
68
Acute Prostatitis dx?
tender prostate on exam! "boggy" | tx just like pyelo just longer!
69
tx of acute prostatitis?
TMP/SMX or Ciprofloxacin for 6-8 weeks
70
how do you workup perinephric abscess?
aka kidney abscess! *someone with pyelo that didnt resolve within 5-7days. --> Sonogram or CT + drainage + Culture + retreat with ABX
71
how do you dx infective endocarditis?
1st = blood culture and vegitations on heart valve or use Dukes criteria
72
whats the most likely dx? how do you work up? pt with fever + new murmer
endocarditis = do blood culture first and if postive follow up with echocardiogram to look for vegitations
73
sx of CHRONIC endocarditis
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
best empiric therapy for endocarditis?
vancomycin + gentamicin
75
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?
COLONOSCOPY to look for pathology! | *bovis and colostridium are associated with colonic pathology and you gotta find it!
76
When do you need to ppx for endocarditis?
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
how do you ppx for endocarditis for dental/oral procedures? alternative?
Amoxicillin If PCN rash: cephalexin If anaphylax: Azithromycin, clarithromycin or clindamycin
78
how do you ppx for endocarditis for skin procedures? alternative?
cephalexin | if allergic: vancomycin
79
endocarditis with MRSA tx
Vancomycin alone is enough
80
endocarditis with a fungus tx?
amphotericin
81
MCC of culture negative endocarditis?
Coxiella
82
HACEK | ^whats this for? whats it mean? tx?
``` difficult to culture endocarditis: Haemophilus aphrophilus/parainfluenza Actinobacillus Cardiobacterum Eikenella Kingella ``` **tx w/Ceftriaxone
83
when should you use rifampin for endocarditis
with prostetic valves and staph infection
84
sx of lyme
stage 1: fever + target rash/erythema migrans stage 2:AV heart block, bells palsy stage 3: arthralgias, confusion
85
tx of nonCNS lyme
doxy, amox or cefuroxime
86
tx of CNS lyme
ceftriaxone
87
HIV/AIDS transmission
IDU, Sex, Transfusion, Perinatal & breastfeeding, Needle stick
88
can kissing transmit HIV?
no!
89
when do you start HIV therapy?
ideally when you know u have the virus! if <500 CD4 you MUST start!, any1 who is symptomatic and pregnant women
90
best dx test for HIV?
ELISA = enzyme linked immunosorbent assay & confirmed with western blot.
91
best dx test for HIV in an infant?
PCR or viral culture | *cant depent on ELISA bc baby has all of moms ab so its gonna be positive no matter what
92
PrEP for HIV
ET = Tenofovir & Emtricitabine before exposure and 1 month after exposure
93
PEP for HIV
ART for a month taht needs to be started within 72 hrs
94
initial HIV therapy?
2 NRTIs and an Integrase inhibitor
95
PCP ppx in HIV <200
TMP/SMX
96
MAC ppx in HIV <50
Azithromycin 1x wk PO
97
tx of Impetigo?
topical mupirocin if severe use dicloxacillin or cephalexin
98
tx of erysipelas
*caused by GAS = really red skin infection | oral docloxacillin or cephalexin
99
tx of cellulitis
augmentin, cefazolin
100
topical antifungal skin tx? when do you use this?
use this if no nails or hair is involved = clotrimazole, nystatin, ketoconazole
101
topical antifungal tx when hair/scalp or nails are involved?
terbinafine, itraconazole, griseofulvin
102
tx of leptospirosis
ceftriaxone or PCN
103
tx of tularemia
doxy, genta or strepto
104
tx of plague
streptomycin, genta, doxy
105
tx of brucellosis
doxy + genta
106
tx of bartonella via bite & via scratch
bite: augmentin scratch: doxy or azithro
107
tx of anthrax
FQ or Doxy
108
tx of babesiosis
azithromycin or atovaquone
109
tx of acute malaria? tx of severe malaria?
acute: mefloquinie severe: artemisinins
110
tx of nocardia
TMP/SMX
111
tx of actinomyces
PCN
112
tx of histoplasmosis, and blastomycosis
amphotericin
113
tx of coccidioidomycosis
itraconazole
114
tx of aspergillus
voriconazole

MTBs Step 3 (30 decks)

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