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Online Med Ed > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

empiric abx coverage: CAP

A

azithromycin (po)
ceftriaxone and azithromycin (IV)
OR
moxifloxacin (PO and IV)

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2
Q

empiric abx coverage: HCAP

A

vancomycin and Pip/Tazo
OR
Linezolid/Meropenem

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3
Q

empiric abx coverage: UTI

A 
amoxicillin (1st line)
nitrofurantoin (if PCN allergy)
TMP-SMX (if no ckd)
cipro (ambulatory pyelonephritis)
ceftriaxone (pyelonephritis)
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4
Q

empiric abx coverage: skin

A

MRSA: vancomiycin -> clinda
MSSA: nafcillin
strep: PCNs

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5
Q

empiric abx coverage: GI

A

ciprofloxacin + metronidazole
OR
ampicillin, gentamycin, metronidazole

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6
Q

empiric abx coverage: C. diff

A

mild: po vanc
severe: po vans + IV metronidazole
recurrent: po fidaxomicin

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7
Q

principles of antibiotics test taking

A

convenience antibiotics are almost always wrong
- ceftriadxone, metronidazole
the stuff the ED always uses will be wrong
- ceftriaxone, vancomycin+pip/tazo
the test will give you a reason for why one of these can’t be used or give you an option that has alternates

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8
Q

alternate for vanc

A

linezolid

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9
Q

alternate for pip/tazo

A

meropenem, cefepime

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10
Q

alternate for ceftriaxone

A

ceftazidime

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11
Q

alternate for cipro

A

ampicillin-gentamycin

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12
Q

HIV path

A

CXCR4 and CCR5 receptors
Gp120
RNA virus
reverse transcriptase

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13
Q

HIV pt

A

opportunistic infections

acute retroviral syndrome (flu)

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14
Q

HIV dx

A 
3rd-gen ab test: if + -> western blot
OR
4th gen ag-ab, confirmation built in 
THEN
viral load and CD4 count
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15
Q

HIV tx

A 
2+1:
2 nucleoside reverse transcriptase-i
AND
1 non-nucleoside reverse transcriptase-i
OR
1 protease inhibitor/ritonavir 
OR
1 fusion inhibitor
OR
1 integrase inhibitor
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16
Q

HIV f/u

A

CD4 climbs 50/yr

viral load fall 1 log in 4wks

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17
Q

ppx to exposure HIV

A 
Pre-exposure ppx 
- emtricitabine + tenofovir
Post-exposure ppx 
- emtricitabine + tenofovir +/- raltegravir
pregnancy 
- AZT
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18
Q

HIV opportunistic infections: PCP

A

CD4 < 200
TMP-SMX (1st line ppx)
dapsone (2nd line ppx)
atovaquone (G6PD, sulfa allergy)

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19
Q

HIV opportunistic infections: toxo

A

CD4 < 100

TMP-SMX

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20
Q

HIV opportunistic infections: MAC

A

CD4 < 50

azithromycin ppx

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21
Q

HIV opportunistic infections: HHV-8

A

kaposi’s sarcoma

purple lesion anywhere on the skin

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22
Q

HIV opportunistic infections: candida

A

oropharynx: nystatin swish & spit (no systemic therapy)
esophagus: fluconazole (systemic therapy for AIDS defining)

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23
Q

TB path

A

acid fast bacillus
spread through cough
caveating granulomas

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24
Q

TB pt

A

asx screen
OR
1st exposure = pneumonia = fever + cough
reactivation = fever, hemoptysis, weight loss, Gohn’s complex

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25
Q

TB risk

A

homeless
foreign travel
prsion

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26
Q

TB dx

A 
asx screen (PPD or Interferon)
- PPD ... read at 48-72hrs
--5mm immunocompromised
--10mm health care workers
--15mm soccer moms
-γ-interferon
--positive or negative
cxr = cavitary lesions, granulomsa
AFB smears + isolation
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27
Q

TB tx

A

if AFB + = RIPE
if AFB - but cxr + = isoniazid + B6
if AFB - and cxr - = isoniazid + B6

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28
Q

TB f/u

A

ignore bcg vaccine (pick γ-interferon if asked to choose)
never PPD if ever the ppd is positive
if AFB +, but weeks later it turns out to be MAC, tx as MAC

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29
Q

RIPE therapy

A

Rifampin
Isoniazid (INH)
Pyrazinamide
Ethambutol

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30
Q

rifampin side effects

A

turns body fluids Red

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31
Q

Isoniazid (INH)

A

B6 deficiency, Neuropathy

always give B6 ppx

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32
Q

Pyrazinamide

A

hyperuricemia

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33
Q

Ethambutol

A

eye, color vision disturbance

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34
Q

SIRS criteria

A

Temp > 38 or < 36
WBC >12 or <4
HR > 90
RR > 20

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35
Q

Severity: SIRS

A

2/4 SIRS criteria

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36
Q

severity: sepsis

A

SIRS + source of infection

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37
Q

severity: severe sepsis

A

sepsis + decrease BP/increase lactate

responsive to volume

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38
Q

severity: septic shock

A

sepsis + decrease BP/increase lactate
unresponsive to volume
(unit, pressers)

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39
Q

early goal directed therapy for sepsis

A

CVP 8-12
MAP >65
U output >0.5cc/kg/hr
SvO2 >70%

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40
Q

actions for sepsis

A 
antibiotics and fluids
pressors
lactate
oxygen
source control
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41
Q

who gets antibiotics and fluids with sepsis

A

everyone, within 6hrs
empiric abx
30cc/kg IVF bolus LR = NS

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42
Q

who gets pressors with sepsis

A

if in shock
1 = norepinephrine
2 = vasopressin
3 = steroids

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43
Q

lactate and sepsis

A

trend lactate for clearance

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44
Q

oxygen and sepsis

A

improve oxygen delivery to tissues

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45
Q

source control sepsis

A

remove plastic (lines, catheter) and drain abscesses

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46
Q

meningitis path

A

bacterial

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47
Q

meningitis pt

A

fever and headache

stiff neck

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48
Q

meningitis dx

A

1st and best: LP

shows many neutrophils

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49
Q

meningitis tx

A

ceftriaxone (everyone)
vancomycin (everyone)
steroids (“everyone”)
ampicillin (immunocompromised)

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50
Q

meningitis f/u

A

syphilis: VDRL, RPR in CSF -> IV PCN
lyme: lyme Ab in CSF -> ceftriaxone
TB: AFB + -> RIPE
Cryptococcus => crypto antigen (not india ink) -> amphotericin
RMSF: RMSF antibody -> ceftriaxone

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51
Q

FAILS for meningitis

A

if FAILS: abx first, then CT, then LP
if NOT fails: LP first, then abx

Focal neurologic deficit
Altered mental status
Immunocompromised
Lesion over site of LP
Seizures
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52
Q

abscess/mass path

A

mass effect

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53
Q

abscess/mass pt

A

fever and headache

focal neurologic deficit

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54
Q

abscess/mass dx

A

1st: CT scan w abx
if AIDS and toxo Ag+ -> treat toxo
- pyrimethamine-sulfadiazine and rescan
if NOT AIDS or NOT toxo Ag + -> biopsy

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55
Q

abscess/mass tx

A 
abscess = abx
cancer = chemo and radiation
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56
Q

abscess/mass f/u

A

repeat CT for toxo

  • shows improvement, continue
  • if not, bx
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57
Q

encephalitis path

A

viral, infection of parenchyma

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58
Q

encephalitis pt

A

fever and headache

AMS

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59
Q

encephalitis dx

A

1st: CT scan w abx
best: LP = lymphocytes
- get HSV PCR

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60
Q

encephalitis tx

A

herpes with acyclovir

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61
Q

encephalitis f/u

A

flaccid paralysis = west nile

temporal lobe = herpes encephalitis

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62
Q

bronchitis path

A

a ‘not that bad’ pneumonia

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63
Q

bronchitis pt

A

fever and a cough

sputum production

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64
Q

bronchitis dx

A

cxr = no consolidation (normal)

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65
Q

bronchitis tx

A

doxycycline, azithromycin

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66
Q

pneumonia path HCAP

A

dialysis, hospitalized, nursing home

risk for MRSA and pseudomonas

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67
Q

pneumonia path CAP

A

no HCAP risk, usual bugs

S. pneumo, M. catarrhalis, H. flu

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68
Q

pneumonia path other

A

klebsiella, think EtOH
mycoplasma, think cold agglutinin disease
staph aureus, think post-viral URI
AIDS, think PCP, TB, fungus, CMV

69
Q

pneumonia pt

A

fever and cough

consolidation physical = increase fremitus, increase egophany, decrease lung sounds, dullness

70
Q

pneumonia dx

A

cxr = consolidation

induced sputum, silver stain for PCP

71
Q

pneumonia tx

A

HCAP: vancomycin, Pip/tazo
CAP: ceftriaxone, azithromycin, or moxifloxacin

72
Q

pneumonia f/u

A 
pneumonia vax (streptococcal)
legionella = get a urine antigen
73
Q

PCP pneumonia path

A

HIV, AIDS, CD4 <200

74
Q

PCP pneumonia pt

A

bilateral interstitial infiltrates

subacute pneumonia

75
Q

PCP pneumonia dx

A

silver stain on sputum

76
Q

PCP pneumonia tx

A

Bactrim IV

steroids if PaO2 < 70

77
Q

PCP pneumonia f/u

A

clues are Increase LDH, but don’t order it

78
Q

abscess path

A

necrosis of the lung

79
Q

abscess pt

A

fever and a cough
sputum production
foul breath

80
Q

abscess dx

A

cxr = cavitation

81
Q

abscess tx

A

abx (I&D if necessary)

82
Q

asymptomatic bacteriuria pt

A

UA for ‘screening’ purposes and happens to be positive

83
Q

asymptomatic bacteriuria tx

A

no tx unless pregnant

84
Q

asymptomatic bacteriuria in pregnancy path

A

pregnant women

85
Q

asymptomatic bacteriuria in pregnancy pt

A

asx screen for pregnant women

86
Q

asymptomatic bacteriuria in pregnancy dx

A

urinalysis = leuk esterase and nitrates

urine culture

87
Q

asymptomatic bacteriuria in pregnancy tx

A

amoxicillin (first line)

nitrofurantoin (if PCN allergy)

88
Q

asymptomatic bacteriuria in pregnancy f/u

89
Q

cystitis path

A

bladder infection = gram negatives

90
Q

cystitis pt

A

urgency, frequency, dysuria

91
Q

cystitis dx

A

urinalysis

urine culture

92
Q

cystitis tx

A 
uncomplicated: 3 d
complicated (Penis, Plastic, Procedure, or ambulance Pyelo): 7 d
Amoxicillin (1st line)
nitrofurantoin (if PCN allergy)
TMP-SMX (optional)
93
Q

pyelonephritis path

A

infection of kidney

94
Q

pyelo pt

A

urgency, frequency, dysuria

nausea, vomiting, CVA tenderness

95
Q

pyelo dx

A

urinalysis = wbc casts

urine culture, blood culture

96
Q

pyelo tx

A

IV abx = ceftriaxone or AMP-Sulbact abx x10d

97
Q

perinephric abscess path

A

walled off kidney infection

98
Q

perinephric abscess pt

A

pyelo that does not get better

99
Q

perinephric abscess dx

100
Q

perinephric abscess tx

A

I&D

14d of abx

101
Q

syphilis path

A

treponema pallidum

102
Q

syphilis pt

A 
primary = single, painless ulcer with lymphadenopathy
secondary = rash and fever, targetoid lesions on palms and soles
tertiary = any neuro symptoms
103
Q

syphilis dx

A 
primary = dark field microscopy
secondary = RPR, confirm with FTA-ab
tertiary = RPR -> LP w CSF RPR and FTA-ab
104
Q

syphilis tx

A 
primary = PCN IM x1
secondary = PCN IM one week x 3 wks
tertiary = PCN IV x 14d
105
Q

syphils f/u

A

PCN allergic? -> doxycycline
pregnant and PCN allergic? -> PCN desensitization
Jarisch-Herxheimer Reaction = fever and symptoms worsen after treatment -> give ASA

106
Q

haemophilus ducreyi path

A

gram negative

107
Q

haemophilus ducreyi pt

A

single, panful ulcer with lymphadenopathy

108
Q

haemophilus ducreyi dx

A

gram stain and culture

109
Q

haemophilus ducreyi tx

A

azithromycin or ciprofloxacin

110
Q

herpes simplex path

A

virus that hides in DRG

111
Q

herpes simplex pt

A

painful burning prodrome

112
Q

herpes simplex dx exam

A

multiple vesicles on erythematous bases
may coalesce to look like one ulcer
no lymphadenopathy

113
Q

herpes simplex dx

A

clinical

HSV PCR

114
Q

herpes simplex tx

115
Q

molluscum contagiosum path

A

self-limiting infection

116
Q

molluscum contagiosum pt

A

central umbilication

multiple ‘vesicles’

117
Q

molluscum contagiosum dx

118
Q

molluscum contagiosum tx

119
Q

lymphogranuloma venerum path

A

C. trachomatis

120
Q

lymphogranuloma venerum pt

A

painless singular ulcer with painful supportive lymphadenopathy

121
Q

lymphogranuloma venerum dx

A

clinical… NAAT if prompted

122
Q

lymphogranuloma venerum tx

A

doxycycline

123
Q

lice path

A

louse lives on hair-bearing regions

sharing hats, combs

124
Q

lice pt

A

itchy scalp

nits in hair

125
Q

lice dx

126
Q

lice tx

A

permethrin shampoo

127
Q

scabies path

A

contact dermatitis from burrowing and pooping bugs/eggs

household contacts

128
Q

scabies pt

A

itching and rash
family members all have it
burrows between fingers and toes

129
Q

scabies dx

A

scrape lesions, see eggs and organisms

130
Q

scabies tx

A

permethrin cream

131
Q

fungal infections path

132
Q

fungal infections pt

A

itchy feet, groin

133
Q

fungal infections dx

A

discoloration of the skin

134
Q

fungal infections dx

A

KOH prep = fungus

culture

135
Q

fungal infections tx

A

hair or nail involved? -> PO antifungals
hair or nail NOT involved? -> topical antifungals
terbinafine is best

136
Q

osteomyelitis path

A 
direct inoculation (probe bone)
indirect inoculation (hematogenous)
137
Q

osteomyelitis pt

A

wound that probes to bone
bone pain
cellulitis anyway (xray for osteo)
recurrent ulcers that do not improve or fail to heal

138
Q

osteomyelitis dx

A

1st: xray
best: MRI
best best: bx

139
Q

osteomyelitis tx

A

surgical debridement
abx
-if not toxic, don’t give any
-if toxic, go broad, deescalate

140
Q

osteomyelitis f/u

A

ESR and CRP (track resolution, not dx)

141
Q

cellulitis path

A

bacterial infection of subQ

142
Q

cellulitis pt

A 
portal = ulcer, puncture, laceration
rash = warm, hot, tender skin with clear demarcations
143
Q

cellulitis dx

A

r/o osteo with xray
r/o osteo - can you probe to bone?
r/o osteo - but only if really concerned, with MRI

144
Q

cellulitis tx

A

S. pneumo: 1st gen cephalosporin

MRSA: vanc IV, clinda or TMP-SMX

145
Q

gas gangrene path

A

dirty wound
gas producing organisms
clostridium perferingins

146
Q

gas gangrene pt

A

cellulitis and crepitus

147
Q

gas gangrene dx

A

1st: xray shows gas

148
Q

gas gangrene tx

A

emergency -> immediate debridement

abx = ß-lactams and clindamycin (inhibits toxin formation)

149
Q

impetigo path

A

strep pyogenes

150
Q

impetigo pt

A

honey-colored crusts, usually on top of another wound or sore

151
Q

impetigo dx

152
Q

impetigo tx

A

amoxicillin

if fails, 1st gen cephalosporin = cephalexin

153
Q

necrotizing fasciitis path

A

rapid spread of infection through fascial planes

strep pneumo

154
Q

necrotizing fasciitis pt

A

rapidly expanding cellulitis
pain out of proportion to exam
diabetes
blue-gray discoloration of skin

155
Q

necrotizing fasciitis dx

A

xray normal

surgical specimen required

156
Q

necrotizing fasciitis tx

A

emergency surgery and debridement
broad abx
hyperbaric oxygen

157
Q

major criteria for endocarditis

A
  • sustained bacteremia by organism known to cause IE (strep, staph, HACEK)
  • endocardial evidence by echo
  • new valvular regurgitation (increase or change of pre-existing not adequate)
158
Q

minor criteria for endocarditis

A
  • predisposing risk factor (valve disease or IVDA)
  • fever > 38 C
  • vascular phenomena (septic emboli arterial, pulmonary, and janeway lesion)
  • immunologic phenomena (glomerulonephritis, Osler nodes, Roth spots, RF)
159
Q

definite endocarditis

A
  • 2 major criteria (blood culture and echo)
  • one major and three minor
  • 5 minor
160
Q

possible endocarditis

A
  • 1 major and 1 minor (almost every bacteremic pt)

- 3 minor

161
Q

rejected endocarditis

A
  • firm alternative dx explaining evidence for IE
  • resolution of everything in 4d
  • no pathologic evidence (biopsy?) at surgery or death
  • failure to meet criteria as above
162
Q

diagnostic steps of subacute endocarditis

A

blood cultures x3

  • one hour apart
  • NO abx
163
Q

diagnostic steps of acute endocarditis

A

blood cultures x2 now

  • start empiric abx
  • f/u cultures
164
Q

if unsure of endocarditis

A

trans thoracic echo

165
Q

if are sure of endocarditis

A

trans esophageal echo

166
Q

antibiotics of endocarditis - native valve

A

vancomycin

167
Q

abx of endocarditis - prosthetic valve

A

< 60d = vancomycin, gentamicin, cefepime
60-365d = vancomycin, gentamicin
>365d = vancomycin, gentamicin, ceftriaxone

168
Q

when to do surgery for endocarditis?

A

> 15mm even without embolization
10mm + embolization
abscess
valve destruction or CHF

Online Med Ed (18 decks)

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