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infectious disease Flashcards

1
Q

what are 4 major gram + cocci bacteria? how are they shaped?

A

staphylococcus aureus - grapes/clusters
staphylococcus epidermitis: grapes/clusters
streptococcus viridans (GABHS) - chains/pairs
Streptococcus pneumococcus - chains/pairs

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2
Q

Staph aureus is found where? how is it spread?

A

normal flora of skin/nose, spread thought lesions, fomites

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3
Q

in diagnosis, how is staph differentiated from strep?

A

staph has catalase (is catalase positive) - aka when its added to hydrogen peroxide, O2 is produced.

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4
Q

treatment options for staph? MRSA?

A

methacillin, nafcillin, dicloxacillin (PCNs)

if MRSA- vancomycin

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5
Q

what diseases can staph aureus cause? (7)

A

skin infections, bacteremia/sepsis, acute endocarditis, PNA, osteomyelitis/septic arthritis, food poisoning, TSS

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6
Q

what does Staph epidermitis infect?

A

assoc. with IV catheters and damaged/ prosthetic heart valves –> insidious onset and less virulent

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7
Q

what diseases does strep (GABHS) cause? (5)

A

skin infection, pharyngitis + scarlet fever + rheumatic fever, mitral valve disease, acute glomerulonephritis, TSS

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8
Q

where is strep viridans found and how does it spread?

A

throat/skin spread through resp. droplets

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9
Q

how is strep diagnosed?

A

catalase negative

beta hemolysis and bacitracin sensitivity = GABHS

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10
Q

treatment for strep?

A

PCN to prevent rheumatic fever

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11
Q

what disease does strep pneumo cause? (3)

A

lobar PNA, adult meningitis, URI (kids)

- found in nasopharynx

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12
Q

what are the 2 gram - cocci? what shaped are the?

A

Neisseria meningitis and Neisseria gonnorhoeae

both: kidney bean shaped

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13
Q

how do you differentiate the two gram - cocci?

A

N. meningitis ferments maltose

N. gonorrhoae does NOT ferment maltose

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14
Q

what 3 dz does N. meningitidis cause?

A

meningococcemia (w/ petechial rash)
meningitis (w/ increased PMNs in CSF)
waterhouse friedrichsen (fever, purpura, DIC, bilateral adrenal hemorrhage, shock, death)

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15
Q

what dz does N. gonorrhea cause?

A

males- urethritis, epididymitis, prostatitis
female- cervicitis, infertility, PID, ectopic, ophthalmia neonatorum

both- septic arthritis

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16
Q

treatment for gram - cocci (Neisseria meningitidis and gonorrhoaea)? prophylaxis?

A

ceftriaxone (general 3 cephalosporin)

prophylaxis: N. meningitidis - rifampin, N. gonnorhoaea - erythromycin eye drops for newborns

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17
Q

what is the likely bacterial meningitis in 0-6months? 6mo - 3 yrs? 3-15yrs? >15 yrs?

A

0-6mo : group B strep, E coli, Listeria
6mo - 3yr: H flu B
3yr- 15 yrs: N. meningitidis
>15yrs: Strep pneumo

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18
Q

what are the gram + rods? (3)

A

Clostridium ( C. tetani, C. botulinum, C. perfungens, C. difficile)
Corynebacterium diptheriae
listeria monocytogenes

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19
Q

what bacteria group are all anaerobic, spore-forming, and with exotoxins ?

A

gram + rods Clostridiums

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20
Q

what is the MOA of C. tetani? C. botulinum?

A

tetani: blocks release of inhibitory glycine neurotransmitter
botulinum: blocks Ach release

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21
Q

what is the MOA of C. difficile?

A

suppression of normal flora allows overgrowth, meds that cause this - clindamycin, ampicillin, cephalosporins

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22
Q

treatment for gram + rods?

A

C. tetani - tetanus immunoglobin +/- (prevention tetanus toxoid)
C. botulinum - antitoxin
C. perfingens - debridement, O2 gas, PCN
C. Diff - metronidazole, vancomycin

Diptheriae- antitox, PCN
listeria- ampicillin

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23
Q

what antibiotic can you NOT use for C. botulinum? why?

A

PCN will burst cells and release the toxin

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24
Q

what does the gram + rod diptheria cause? (3)

A

gray fibrinous exudate in throat (pseudomembrane) - airway obstruction, myocartidis, recurrent laryngeal nerve palsy

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25
Q

what does the gram + rod listeria monocytogenes cause?

A

neonatal meningitis and sepsis, premature delivery

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26
Q

where does listeria monocytogenes come from?

A

transmitted to humans from animal feces, veggies, UNPASTURIZED MILK/CHEESE

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27
Q

what bacteria are included in the gram - rods? (4 major groups with subgroups)

A
  1. Enteric- E coli, Salmonella, Shigella, Vibrio (cholera), campylobacter, helicobacter pylori
  2. Enteric-extraintestinal - klebsiella, pseudomonas
  3. Respiratory- H flu, legionella, pertussis
    • zoonotic- brucellosis, tularemia, yersinia pestis (plague), pasturella
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28
Q

what does E coli cause? (4)

A

MC- UTI, gram - sepsis, traveller’s diarrhea (watery), neonatal meningitis
*can produce blood if it produces shiga toxin

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29
Q

how is E coli differentiated from salmonella and shigella on dx?

A

it DOES ferment lactose

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30
Q

Ecoli treatment

A

generation 3 cephalosporin (ceftriaxone, cefixime)

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31
Q

what does Salmonella cause? (3)

A

gastroenteritis ( diarrhea +/- blood ), typhoid fever, gram - sepsis

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32
Q

how can you distinguish salmonella from Ecoli and shigella on dx?

A

does NOT ferment lactose like Ecoli does

DOES produce H2S gas + enters bloodstream (unlike shigella)

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33
Q

treatment for salmonella

A 
PCN - ampicillin, amoxicillin 
doxycycline
TMP/SMX 
Ceftriaxone 
cipro
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34
Q

what 3 bacteria are NOT susceptible to TMP/SMX?

A

pseudomonas, tularemia, mycoplasmae

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35
Q

what causes these? gross bloody diarrhea, small blood diarrhea, traveller’s diarrhea, massive rice-water diarrhea, daycare outbreak diarrhea

A 
gross blood- campylobacter 
small blood- salmonella
traveller's - Ecoli (+/- watery, blood) 
massive/rice water - cholera
daycare- shigella
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36
Q

transmission and patho of shigella?

A

NOT normal human flora, fecal - oral, invades distal ileum + colonic, NOT spread through blood (like salmonella)

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37
Q

treatment for shigella and cholera?

A

rehydrate

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38
Q

treatment for campylobacter

A

macrolide (azithromycin, erythromycin)

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39
Q

macrolide coverage (azithromycin, erythromycin, clarithromycin)

A

gram + and some gram - (H flu, pertussis)

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40
Q

aminoglycoside coverage (gentamycin, streptomyocin, tobramycin, amikacin)

A

aerobic gram - ( enterobacter, pseudomonas)

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41
Q

tetracycline (doxycycline) coverage

A

broad: aerobic, anaerobic, gram + and gram -

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42
Q

what does helicobacter pylori cause?

A

gastritis, peptic ulcer, risk for gastric carcinoma

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43
Q

Dx helicobacter pylori

A

urease +

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44
Q

Txt for helicobacter pyloric

A

tetracycline, metronidazole

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45
Q

what does gram - rod klebsiella-enterobacter-serratia cause?

A

opportunistic pathogen - UTI, PNA

severe, bloody sputum, lung cavitation

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46
Q

what does gram - rod pseudomonas cause?

A

opportunistic pathogen - PNA, osteomyelitis, burn infection,malignant otitis externa

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47
Q

treatment for pseudomonas

A
  1. pipercillin- ticarcillin (extended specturm PCN) and aminoglycoside (gentamycin)
  2. ceftazadime ( gen 3)
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48
Q

what does H flu cause?

A

leading cause of meningitis in kids, epiglottitis

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49
Q

txt for HIB?

A

rifampin (prevents meningitis and transmission)

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50
Q

what does legionella pneumophilia cause?

A

atypical pneumonia with high fever, productive cough

airborne from water sources

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51
Q

txt for gram - rods legionella?

A

macrolide (erythromycin)

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52
Q

how do you get campylobacter?

A

gram - rod, ingestion of contaminated food or from domestic animal

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53
Q

what is the ONLY abx that will cover listeria?

A

ampicillin

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54
Q

CSF of lyme disease that has disseminated into CNS will show what? how is it treated ?

A

lymphocytes and moderate increase in proteins

CNS lyme = ceftriaxone

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55
Q

txt for latent TB

A

isoniazid for 9 months or Rifampin for 4 months

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56
Q

what medication is given with isoniazid to prevent neuropathy?

A

pyridoxine

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57
Q

treatment for lyme disease in pregnancy/children?

A

amoxicillin

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58
Q

compare and contrast rubella and rubeola (measles)

A

both start on face and spread downward BUT rubeola (measles) has a prodrome of cough, coryza and koplik spots.
“rub lotion on your face first, then your body”
“rub it all over if it starts with cough, coryza, koplik”

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59
Q

child with HIGH fever for 4 days, then a blanching, nonpruritic rash that starts on the trunk and spreads outwards

A

roseola

“blooms from inward to out like a rose”

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60
Q

slapped cheeks and lacy exanthem… what is the disease and the virus that causes it?

A

erythema infectiosum (parvovirus B19)

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61
Q

CSF for meningitis: INDIA INK STAIN shows encapsulated yeast forms ?

A

cryptococcus neoformans

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62
Q

What finding on a Tzank smear confirms the diagnosis of an HSV infection?

A

multinucleated giant cells

63
Q

condyloma accuminata is what? condyloma lata is what?

A

accuminata: genital warts (HPV)
lata: secondary syphillis (flat velvety moist near the chancre)

64
Q

Patients diagnosed with chlamydia or gonorrhea should be counseled to avoid sexual contact for how long?

A

7 days after finishing the abx

65
Q

what disease comes from unpasturized milk products or handling meat/animals and causes undulating fever (high during the day at low at night)?

A

Brucella (gram - rod)

66
Q

what disease comes from an animal/mite bite and causes ulceroglandular lesions (holes in skin, black base, swollen lymph and draining pus) ?

A

Tularemia (gram - rod)

67
Q

what disease comes from prairie dogs/ rats/ fleas from urban centers?

A

yersinia pestis (black plague) (gram - rod)

68
Q

what disease comes from normal flora or cats/dogs, transmitted through a bite, causes RAPID cellulitis from the bite and possible osteomyelitis?

A

pasturella multocida

69
Q

what is the treatment for pasturella ?

A

PCN

70
Q

what are the acid-fast rods?

A

Mycobacteria tuberculosis and mycobacterium Avium

71
Q

treatment for mycobacterium avium?

A

Azithromycin or clarithromycin

72
Q

what is type of organism is mycoplasma pneumoniae? what does it cause?

A

small-free living, virus- like.

walking pneumonia

73
Q

Dx and treatment for walking pneumonia

A

Dx- positive cold agglutinins

Txt- erythromycin or tetracycline

74
Q

what are the 4 “big dogs” of Abx?

A

doxycycline (a tetracycline)
clindamycin
linezolid
TMP/SMX (bactrim)

75
Q

what is amphotericin B used to treat? (3)

A

fungal sinusitis, cryptococcosis (MC fungal meningitis), candidal endocarditis

76
Q

both from inhaled bird droppings, what regions are cryptococcosis and histoplasmosis found?

A

cryptococcosis- southwest

histoplasmosis - midwest

77
Q

how do you diagnose cryptococcosis?

A

india ink stain = encapsulated yeast

78
Q

how is histoplasmosis (atypical PNA) diagnosed?

A

sputum PCR

79
Q

what is the treatment for PJP?

A

TMP/SMX (bactrim)

80
Q

how are most helminths diagnosed?

A

eosinophilia

* trichenollosis = muscle biopsy shows larva in striated muscle

81
Q

how are most helminths treated? what if the pt is pregnant?

A

albendazole or mebendazole

*pyrantel if pregnant

82
Q

what is enterobius vermicularis? how is it treated?

A

pinworm

txt: albendazole/mebendazole

83
Q

what are the ToRCH syndrome diseases? what can they cause?

A

Toxoplasmosis, other (includes Zika now), Rubella, CMV, Herpes
- congenital: blueberry muffin rash (TTP), hearing loss, hepatosplenomegaly, developmental delays

84
Q

what shows “ring-enhancing lesions” on CT/MRI? what is the source?

A

toxoplasmosis (protozoa from cat feces or uncooked meat)

85
Q

treatment for toxoplasmosis? what if they are currently pregnant?

A

sulfadiazene (or clindamycin) + pyrimethamine. (w/ folinic acid and leuovorin to prevent bone marrow suppression)
PREGENANT = SPIRAMYCIN

86
Q

what does trichenellosis cause?

A

GI upset –> muscle phase (myositis + periorbital edema) –> PNA + CNS involvement

87
Q

how is botulism treated?

A

<1 yo - human-derived antiTox

>1yo - equine-derived antiTox

88
Q

what treatment is used for wound botulism but NOT for foodborne type? why?

A

wound - PCN G

*may worsen dz from bacteria lysis toxin release

89
Q

what is nucleic-acid amplification used to diagnose?

A

chlamydia, gonorrhea, trichomoniasis

90
Q

friable white exudate that bleeds when scraped off can be a sign of what two things?

A

thrush (oral candida) and diptheria

91
Q

treatment for diptheria

A

equine- antiTox +erythromycin or PCN

92
Q

signs and symptoms of salmonella?

A
  • pea soup diarrhea +/- blood (gastroenteritis) +crampy abdominal pain
  • typhoid (enteric)fever: + fever, bradycardia, rash
  • osteomyelitis (if sickle cell)
93
Q

how is salmonella diagnosed?

A

blood culture

94
Q

treatment for salmonella and shigella ?

A

fluids +/- TMP/SMX or fluoroquinolones

95
Q

sign of shigella?

A

BLOODY diarrhea +/- sigmoidoscopy showing areas of ulceration

96
Q

MC cause of erysipelas? cellulitis?

A

erysipelas - group A strep

cellulitis- staph

97
Q

treatment of erysipelas?

A

IV PCN or vancomycin if PCN allergy or MRSA

98
Q

what type of rash does TSS cause?

A

diffuse erythematous (sunburn-like) + desquamation

99
Q

treatment for TSS

A

admit, fluids, clindamycin + vancomycin

100
Q

treatment for MRSA

A

TMP/SMX

101
Q

signs and symptoms of rheumatic fever

A 
JONES criteria (major): Joints, Oh No carditis, Nodules, Erythema marginatum, Syndeham chorea 
minor: fever, polyarthalgia, increased ESR/CRP, prolonged PR interval
102
Q

modified jones criteria for 1st infection: how many major/minor do you need

A

+ strep test plus 2 major OR 1 major, 2 minor

103
Q

Txt for rheumatic fever

A

ASA for carditis, PCN

*macrolides if PCN allergic

104
Q

what two viruses do you need acyclovirs for?

A

CMV - ganiciclovir
herpes- acyclovir
*the rest are supportive

105
Q

Dx of CMV

A

PCR

106
Q

3 complications of mono?

A

encephalopathy, meningitis, guillan barre

107
Q

what CA is mono assosciated with?

A

hodgekins lymphoma (Burkitts)

108
Q

peripheral smear for mono shows what?

A

> 10% atypical lymphocytes

109
Q

erythema infectiosum : how can it present in children? adults? sickle cell pts?

A

aka parvovirus B19
children: slapped cheeks –> lacy reticular rash
adults: + arthropathy
SS: aplastic crisis

110
Q

“1st is the worst” applies to what virus?

A

herpes, first outbreak is the worst/most painful

111
Q

CD4 count and associated diseases( < 200, <150, <100, <50). which do you prophylax for?

A

< 200: PJP w/ TMP/SMX
< 150: histoplasmosis w/ fluconazole
< 100: toxoplasmosis w/ TMP/SMX + cryptococcosis
<50: CMV + MAC

112
Q

diagnosis of rabies?

A

PCR

113
Q

what is ramsey hunt syndrome?

A

Varicella-zoster involvment of genicular/facial nerve: vesicular rash in ear, unilateral facial paralysis, tinnitus/hearing loss

114
Q

treatment for ramsey hunt?

A

acyclovir + steroids, maybe TCA or gabapentin for facial paralysis

115
Q

Dx for TB and MAC?

A

acid-fast bacilli

116
Q

treatment for MAC?

A

clarithromycin + ethambutol

117
Q

what are the 3 spirochetal diseases?

A

lyme, RMSF, syphillis

118
Q

Dx of lyme?

A

ELISA test, Western blot

119
Q

Dx of syphillis?

A

RPR and VDRL, confirm with FTABS

120
Q

what organism causes acute sinusitis? chronic sinusitis?

A

acute: Strep pneumo, H flu, Mcatt
chronic: staph aureus

121
Q

txt for bacterial sinusitis?

A

Amox

second line - doxycycline or TMP/SMX

122
Q

treatment for AOM?

A

amox or augmentin or cefdinir

123
Q

MC route of infection for PNA

A

microaspiration of oropharyngeal secretions

124
Q

CAP organisms vs HAP organisms

A

CAP: S pneumo, Hib, Mcatt. *atypical (mycoplasma pneumo. aka walking PNA)
HAP: gram neg rods (pseudonomas, E coli, klebsiella)

125
Q

what organism causes PNA after a viral illness like the flu?

A

Staph aureus

126
Q

klebsiella PNA shows what on CXR?

A

cavitary lesions

127
Q

macrolides have what kind of coverage? in general what infections are they good for?

A

gram + with some gram neg. good for resp. infections

128
Q

CXR for PNA

A

sillouhette sign

  • lobar = typical
  • patchy interstitial = atypical
129
Q

what is CURB 65?

A

assessment to see if PNA needs hospitalization. Confusion, Urea >7mmol, RR >30, BP <90/60, age >65
each counts for 1. score 3-5 = admission

130
Q

txt COPD exacerbation

A

bronchodilators, O2, steroids

+ Abx (azithromycin) if increased/ change in sputum or CXR showing infection.

131
Q

treatment for cellulitis

A

cephalexin, amox or dicloxacillin

MRSA= TMP/SMX, doxy or clinda

132
Q

who is most likely to get osteomyelitis?

A

MC <20yo or immunocompromised

133
Q

organisms that cause osteomyelitis?

A

Staph aureus (also GABHS)
immunocompromised - salmonella
prosthetic - Staph epidermis
IV drugs - pseudomonas

134
Q

treatment for osteomyelitis?

A 
staph/strep = PCN or vancomycin 
salmonella/pseudomonas= FQ
135
Q

txt for pyelonephritis

A

FQ for 14 days

136
Q

prostatitis organism and treatment : <35yo vs >35yo

A

<35 yo : Gonorrhea/chlamydia : ceftriaxone + doxy/azithromycin
>35 yo : E coli : FQ or TMP/SMX

137
Q

which valve is MC infected with endocarditis? what if its from IV drug use?

A 
mitral valve 
(but it IV drug use = tricuspid)
138
Q

acute vs subacute endocarditis?

A

acute: normal valve, virulent organism (staph aureus)
subacute: abnormal valve, less virulent (strep viridans)

139
Q

what organisms cause endocarditis for those with prosthetic valve? IV drug use?

A

prosthetic valve: Staph epidermitis

IV drugs: MRSA, pseudomonas, candida

140
Q

endocarditis within <60 days of inoculation? >60 days?

A

<60 days : most likely prosthetic valve

>60 days : native valve

141
Q

Dx endocarditis

A

blood culture before antibiotics, 3x 1 hr apart each.

CBC, EKG, Echo

142
Q

txt for endocarditis (acute, subacute, prosthetic, fungal): time period and drugs for each

A

4-6 weeks of …

acute: nafcillin + gentamicin (aminoglycoside)
subacute: nafcillin + gentamicin + ampicillin
prosthetic: gentamicin + vancomycin + rifampin
fungal: amphotericin B

143
Q

what do aminoglycosides (GNATS) cover?

A

primarily gram neg (pseudomonas, enterobacter) and TB

144
Q

secondary syphillis shows what?

A

diffuse rash, palms + soles w/ desquamation + lymphadenopathy

145
Q

what is the jarisch-hercheimer rxn?

A

24 hrs after syphillis treatment = flu-like symptoms from the detox

146
Q

what causes spontaneous bacterial peritonitis?

A

portal HTN –> bowel edema –> bacterial migration from GI tract

147
Q

Dx of spontaneous bacterial peritonitis?

A

paracentesis: fluid has >250 PMNs

148
Q

treatment for spontaneous bacterial peritonitis? what bugs is it to cover?

A

cephtriaxone (or other 3rd gen cephalosporin)

- covers Ecoli, klebsiella, strep pneumo

149
Q

dx of bacterial meningitis?

A

high opening pressure, CSF predominance of neutrophils >1000, decreased glucose, increased proteins

150
Q

organisms of meningitis: <1 mo, 1mo-18yrs, 18-50, >50

A

<1mo: group B strep, Listeria
1mo - 18 yrs: Neisseria meningitis MC, S pneumo, Hflu
18-50: S pneumo MC, N. meningitis, Hflu
50+: S pneumo, Listeria

151
Q

txt for meningitis: < 1mo, >1mo-50, 50+

A

<1mo: ampicillin + 3rd gen cef or aminoglycoside
>1mo - 50: 3rd gen cef + vancomycin
50+: ampicillin + 3rd gen cef

152
Q

uncomplicated UTI txt?

A

5-7days
macrobid (nitrofurantoin)
*or FQ, TMP/SMX

153
Q

complicated UTI/pyelonephritis txt? pregnant?

A

14 days
FQ or aminoglycoside
pregnant = amoxicillin or macrobid(nitrofurantoin)

154
Q

what makes a UTI complicated?

A

> 7 days, pregnant, DM, immunocomprimised, elderly, male

Rotation (16 decks)

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