Infectious Disease Flashcards
Medications that can cause drugs induced pancreatitis?
Drug-induced pancreatitis (DIP) accounts for approximately 1% of cases of pancreatitis. Thiazide diuretics (eg, hydrochlorothiazide, chlorthalidone) and most loop diuretics (eg, furosemide) belong to the sulfonamide class of drugs and have been associated with DIP. These drugs likely cause DIP through several pathophysiologic mechanisms, which include hypersensitivity to the sulfonamide molecule, ischemia due to decreased intravascular blood volume, and increased viscosity of pancreatic secretions. Numerous other medications have been associated with DIP and act through the same or other pathophysiologic mechanisms (eg, toxicity from metabolites, intravascular thrombosis). Diagnosing DIP can be difficult and requires careful consideration of the patient’s medication history. Although the rates of DIP for any specific medication are low, certain medications are more strongly associated with the disease. Given the wide range of medications involved, physicians should be aware of a number of common groups of patients who are at higher risk for DIP. These include patients with the following: *Heart failure or hypertension (ACE inhibitors, angiotension II receptor blockers, diuretics) *Autoimmune disease (azathioprine, mesalamine, corticosteroids) *Chronic pain (acetaminophen, opiates, nonsteroidal anti-inflammatory drugs) *Seizure disorder (valproic acid, carbamazepine) *HIV (lamivudine, didanosine, trimethoprim-sulfamethoxazole)
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
what type of meningitis is associated with….HIV positive with <100 CD4
cryptococcus
arthralgia, myalgia, cough, headache, fever, sore throat and feeling of tiredness. dx? what if your unsure of the dx how would you confirm?
flu! *confirm w/nasopharyngeal swab of rapid antigen detection if your sure about dx u can treat
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
how do you treat widespread scabies(like total body scabies)
Ivermectin
tx of HSV ulcers? what if resistant?
acyclovir! resistant do ganciclovir
sx of cystitis? MCC?
urinary frequency, urgency, burning, and dysuria MCC = E.Coli
Sx of Scabies
smalle, burrows in webs of fingers, scrape and magnify
what type of meningitis is associated with…. young kid with petechial rash
meningitidis
when should you use rifampin for endocarditis
with prostetic valves and staph infection
Tx of herpes encephalitis? what if its resistant?
- Acyclovir if resistant = Foscarnet
sx of acute heptatitis
jaundice, fatigue, weight loss, dark urine caused by increased bilirubin in urine
PEP for HIV
ART for a month taht needs to be started within 72 hrs
woman has HSV encephalitis & is being treated with standard medication but her Creatinine level rises. what do you do?
reduce acyclovir and hydrate = she needs to get rid of the HSV! dnt switch to foscarnet bc thats worse on the kidneys than acyclovir
tx of leptospirosis
ceftriaxone or PCN
tx of nocardia
TMP/SMX
which type of hepatitis can be deadly in pregnant women?
hepatitis E
how do you ppx for endocarditis for dental/oral procedures? alternative?
Amoxicillin If PCN rash: cephalexin If anaphylax: Azithromycin, clarithromycin or clindamycin
tx of nonCNS lyme
doxy, amox or cefuroxime
what are the FAILS criteria? what are they used for?
if any of the fails + then dnt do a LP and do a CT first. FND AMS Immunocompromised Lesions Seizures
tx of Epididymo-Orchitis
<35yoa = Ceftriaxone and doxy >35 yoa = FQ
initial HIV therapy?
2 NRTIs and an Integrase inhibitor
PCP ppx in HIV <200
TMP/SMX
For how long is someone with active shingles contagious? How is the virus spread?
Patient is contagious until lesions are completely crusted over. Viruses spread via direct contact or rarely aerosolization.
Tx of bacterial meningitis
ceftriaxone+vancomycin + steroids
*start abx immediatly after blood cx as even a short delay can increase mortality, do not delay abx if LP cannot be performed! If FAILS sx = CT before LP
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
common meningitis caused by gram - diplococci
neisseria
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
Symptoms of disseminated gonococcal infection?
DGI occurs when Neisseria gonorrhoeae spreads from the urogenital tract to the bloodstream. Patients with DGI are typically unaware of the urogenital infection and usually seek clinical attention with either mono- or oligoarthritis or a triad of manifestations including: Dermatitis — 2-10 painless pustules on the distal extremities Tenosynovitis — swelling and pain with passive extension of multiple tendons Polyarthralgia — asymmetric small and large joint arthralgias Systemic symptoms such as fever and generalized malaise are also common. Patients with suspected DGI should receive blood cultures and synovial fluid sampling (if there is an accessible joint effusion), but these tests have low diagnostic sensitivity. Most patients are diagnosed presumptively when nucleic acid amplification testing of the urogenital tract is positive for N gonorrhoeae. Testing for other sexually transmitted infections (eg, HIV, Chlamydia) should also be performed.
tx of sinusitis?
augmentin or doxy for 7-10 days if does not resolve with supportive therapy after 10 days
Treatment of acute, subacute & post herpectic neuralgia/shingles pain?
*Acute herpectic neuralgia (<30 days) = NSAIDs, analgesics *Subacute herpectic neuralgia(30 days-4 months) = NSAIDs & analgesics *Post herpectic neuralgia (>4 months) = TCA, gabapentin & pregabalin
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
can kissing transmit HIV?
no!
Tx of Urethritis &/or Cervicitis in prego?
Ceftriazone IM + Azithromycin *no doxy bc can mess with baby bones + teeth
MCC of culture negative endocarditis?
Coxiella
What is Tabes Dorsalis?
loss of position and vibratory sense, incontinence and CN abnormalites due to syphilis involving the posterior colums
HACEK ^whats this for? whats it mean? tx?
difficult to culture endocarditis: Haemophilus aphrophilus/parainfluenza Actinobacillus Cardiobacterum Eikenella Kingella **tx w/Ceftriaxone
Chancroid v syphilis v lymphogranuloma venereum v HSV ulcers sx?
Chancriod = painful ulcers Syphilis = painless ulcers Lymph = painful LYMPH HSV = painless lymph + painful ulcer
endocarditis with MRSA tx
Vancomycin alone is enough
tx of plague
streptomycin, genta, doxy
tx of actinomyces
PCN
tx of CNS lyme
ceftriaxone
Tx of Rickettsia meningitis
doxycyclin
Acute Prostatitis dx?
tender prostate on exam! “boggy” tx just like pyelo just longer!
tx of acute malaria? tx of severe malaria?
acute: mefloquinie severe:artemisinins
tx of histoplasmosis, and blastomycosis
amphotericin
what is the best initial test for OM? 2nd test? most accurate?
Xray > MRI > bone bx
When can postexposure ppx be used for HIV?
started <72 hr after exposure, idealy 1-2hrs
what is the MC mechanism of spread of infection to bone?
OM caused by direct contiguous spread from teh overlying tissue to the bone.
causes of bloody diarrhea
campylobacter, salmonella, vibrio, e.Coli, shigella, yersinia, amebic
Tx of urethritis &/or Cervicitis
Ceftriazone IM + Azithromycin 1x and then Doxy for 7days
HIV/AIDS transmission
IDU, Sex, Transfusion, Perinatal & breastfeeding, Needle stick
What is Argyll-Robertson Pupil?
eyes accommodate to objects but do not respond to light.
Intertrigo Cause? Tx?
Inflammatory skin condition affecting the intertriginous areas. Mcc Candida albicans. Dx is clinical but can be confirmed with koh Tx topical antifungals (miconazole, nystatin, terbinafine)
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)
best empiric therapy for endocarditis?
vancomycin + gentamicin
endocarditis with a fungus tx?
amphotericin
tx of acute prostatitis? chronic?
- If Acute: FQ, IV pip/tazo, 3rd gen cephalosporin for 14 days
- If Chronic: FQ or Bactrim for 4-6 weeks
sx of Pediculosis?
aka CRABS larger than scabies, in hair-bearing areas such as the pubic or axilla, visible on the surface
tx of Granuloma Inguinale
Doxy, TMP/SMX or Azith
tx of brucellosis
doxy + genta
tx of complicated cystitis?
7d TMP/SMX or ciprofloxacin
Old fart with wicked SCC of the esophagus hospitalized with WBC of like 300 or something. Started on TPN then after 4 days develops 102 fever, right eye pain & light sensitivity. Funduscopic exam several large, glistening, off-white lesions with indsitinct borders. dx? tx?
Candida Endophthalmitis 2/2 central venous cathether for TNP tx: vitrectomy & amphotericin B
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!
tx of osteomyelitis?
4-6 weeks with vancomycin + pip/tazo untill cultures return
which is elevated more AST or ALT in hepatitis/
ALT > AST
tx of lyme meningitis
ceftriaxone
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
Tx of Lymphogranuloma venereum?
Aspirate the bubo then doxy or azith *remember this is chlamydia trachomatis
common meningitis caused by gram - pleomorphic, coccobacillary organism
Haemophilus
best dx test for HIV?
ELISA = enzyme linked immunosorbent assay & confirmed with western blot.
inpatient treatment for PID
Cefoxitin or Cefotetan IV and doxy
which neurominidase inhibitors only work against influenza A and shouldnt be used for the seasonal flu?
amantidine and rimantadine *use oseltamivir and zanamivir for the seasonal flu as it covers both A & B
Treatment of mononucleosis? Treatment if there is concern for impeding airway obstruction ?
Normal treat with Tylenol/NSAIDs. If concern for airway obstruction Corticosteroids are warranted in the treatment of infectious mononucleosis (IM) in rare cases when airway obstruction appears imminent; common warning signs include shortness of breath while recumbent, tachypnea, and inability to swallow. Corticosteroids may also be considered in patients with IM who are immunocompromised or are experiencing other serious complications (eg, aplastic anemia, overwhelming infection, thrombocytopenia).
Treatment for shingles
PO valacyclovir q7 days
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
rickettsia!
tx of aspergillus
voriconazole
how do you ppx for endocarditis for skin procedures? alternative?
cephalexin if allergic: vancomycin
Tx of Chancroid?
PO azithromycin 1x OR IM ceftriaxone
tx of uncomplicated cystitis? what if its resistant?
tx Fosfomycin or Nitrofurantoin PO 3d resistant: Ciprofloxacin or Levofloxacin
tx of syphillis ulcers?
IM PCN
tx of pyelonephritis?
ciprofloxacin inpatient: ciprofloxacin, ampicillin + gentamicin =these are all excreted in high concentration in urine =)
tx of otitis media
Amoxicillin, if recurrent = augmentin or cefdinir
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!
sx of lyme
stage 1: fever + target rash/erythema migrans stage 2:AV heart block, bells palsy stage 3: arthralgias, confusion
tx of babesiosis
azithromycin or atovaquone
how do you tx the flu?
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
tx of coccidioidomycosis
itraconazole
tx of Impetigo?
topical mupirocin if severe use dicloxacillin or cephalexin
common meningitis caused by gram + diplococci
pneumococcus
tx of cryptococcus meningitis
amphotericin & 5FU + fluconazole
what type of meningitis is associated with….recently been camping
lyme
how do you dx infective endocarditis?
1st = blood culture and vegitations on heart valve or use Dukes criteria
tx of bacterial meningitis in immunocomp pt
ceftriaxone+ vancomycin + steroids + AMPICILLIN for listeria coverage
tx of otitis externa?
topical abx(ofloxacin, ciprofloxacin) + topical hydrocortisone to decrease swelling
tx of cellulitis
augmentin, cefazolin
outpatient treatment for PID
Ceftriaxone IM and Doxy oral or cefoxatine
tx of erysipelas
*caused by GAS = really red skin infection oral docloxacillin or cephalexin
tx of Scabies
Permethrin > Lindane *same as pediculosis
Meningitis vs Encephalisits
Meningitis: FND, Papilledema, seizures, AMS, fever, HA, STIFF NECK, photophobia Encephalitis: Fever + CONFUSION
PID sx? dx?
lower abdominal pain, tenderness, fever, cervical motion tenderness**, leukocytosis 1. PREGO tests 2. cervical culture and NAAT test
BIG BEEFY ulcer on genital/perineum? dx?
Granuloma Inguinale = Klebsiella Granulomatis *this is BIG & BEEFY
topical antifungal tx when hair/scalp or nails are involved?
terbinafine, itraconazole, griseofulvin
Viral vs bacterial meningitis vs crypto/lyme/rickettsia vs TB cell count, protein, glucose, stain
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
MAC ppx in HIV <50
Azithromycin 1x wk PO
tx of tularemia
doxy, genta or strepto
what type of meningitis is associated with….elderly, neonatal or HIV +
listeria
if you suspect encephalitis what 2 test do u wanna run?
Head CT > PCR of CSF to confirm HSV(MC)
What is the best initial treatment for severe diarrhea(blood, fever, abdominal pain, hypotension, tacycardia) if you dnt know the cause?
FQ like ciprofloxacin
tx of anthrax
FQ or Doxy
MCC of osteomyelitis?
staphylococcus
PrEP for HIV
ET = Tenofovir & Emtricitabine before exposure and 1 month after exposure
tx of bartonella via bite & via scratch
bite: augmentin scratch: doxy or azithro
common meningitis caused by gram positive bacilli
listeria
tx of Pediculosis
Permethrin > Lindane
For how long does the lympadenopathy last for mono?
2-3 weeks, if persist longer observe for another 3-4 weeks then send for bx
Tx of Necrotizing Fasciitis
dx w/ CT or MRI
Tx w/ PCN for coverage of GAS + Vanc for MRSA, if concerned for mixed infection may need broad spectrum PCN w/Zosyn
dx & tx of orbital cellulitis
dx with CT orbit, blood cx & cbc. Tx w/IV abx to cover gram negative rods(rocephin, amp/sulbactam) + vanc
*increase risk of cavernous sinus thrombosis
treatment of west nile encephalitis
dx w/ELISA & treatment is supportive
MCC of bacterial meningitis in:
- Neonates(0-4 weeks)
- Infants(1-23m)
- Ages 2-50
- Ages 50+
- Neonates(0-4 weeks) = GBS, Ecoli, Listeria
- Infants(1-23m) = S. Pneumo, N. Meningitidis, H. Influ
- Ages 2-50 = S. Pneumo, N. Meningitidis
- Ages 50+ = S. Pneumo, N. Meningitidis, Listeria
Strep vs Mono
which has anterior/posterior lymphadenopathy?
Strep = anterior
Mono = posterior
How long must a pt avoid contact sports with mono?
How long does lympadenopathy last?
How long does fatigue last?
at least 4 weeks with no contact sports to avoid splenic rupture. Lymphadenopathy can last 2-3 weeks, if last long monitor for another3-4 weeks then send for bx if not resolving. Fatigue can last for months
Presentation of typical vs atypical pneumonia
typical = fever, productive cough, dyspnea, pleuritic chest pain
atypical = low grade fever, nonproductive cough, myalgias
CURB 65 scoring
Confusion, Urea >19, RR>30, BP <90/60, Age >65
1 = outpatient
2= hospitalized
3= consider ICU
4+ = ICU
Tx PCP pneumonia?
B-D-glucan level?
TMX-SMX or IV pentamidine
BDGlucan level >500U/L
Bronchitis sx, dx, tx?
SX: cough, +/- sputum production, dyspnea, fevers & rarely chills. Lungs clear with upper airway noise
DX: clinical(>5d cough), negative CXR to r/o pneumonia
TX: majority of patient do not need abx, supportive therapy only
PT who recieved TB vaccine can be tested for TB w/…..
Interferon-gamma release assay(IGRA) = no false postive
Positive TB Skin Test for HIV pts, Immunocompromised, recent contact with TB, CXR consistent with TV infection
>5mm
Positive TB Skin Test for healthcare workers, immigrants from endemic areas, pt with chronic illnesses(COPD, CKD, DM, Posttransplant, Cancer), Homeless persons, IV drug users
>10 mm
Positive TB Skin Test for low risk of disease with no risk factors for TB
>15 mm
Common side effect of:
Zidovudine
myopahty and bone marrow supression
Common side effect of: Didanosine
pancreatitis
Common side effect of: Abacavir
hypersensitivity reaction(fever, chills, dyspnea)
Common side effect of: Entricitabine
diarrhea, N, headache
Common side effect of: Tenofovir
renal toxicity
Treatment of sporotrichosis
sx?
SX: seen in landscapers or gardeners, skin papule w/ulceration & nonpurulent drainage, Lesions long lymph train & lymphadenopathy
TX: 3-6m of Itraconazole
Treatment of active TB in prego?
Treatment usually involves 3-drug therapy with isoniazid (INH), rifampin (RIF), and ethambutol for 2 months followed by INH and RIF for 7 additional months. All 3 of these medications cross the placenta but are not associated with significant fetal toxicity. Pyrazinamide, part of the 4-drug TB treatment given to most nonpregnant individuals, is generally not administered to pregnant patients due to uncertain teratogenic properties and little contribution to overall TB treatment efficacy.
Pregnant women undergoing treatment for TB should also receive pyridoxine (vitamin B6) supplementation to prevent INH-induced neurotoxicity. Counseling about medication side effects and monthly monitoring for disease response and drug-associated hepatitis are required.
