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Step 3 UW /FA > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Medications that can cause drugs induced pancreatitis?

A

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)

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2
Q

when do you start HIV therapy?

A

ideally when you know u have the virus! if <500 CD4 you MUST start!, any1 who is symptomatic and pregnant women

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3
Q

what type of meningitis is associated with….HIV positive with <100 CD4

A

cryptococcus

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4
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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5
Q

best dx test for HIV in an infant?

A

PCR or viral culture *cant depent on ELISA bc baby has all of moms ab so its gonna be positive no matter what

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6
Q

how do you treat widespread scabies(like total body scabies)

A

Ivermectin

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7
Q

tx of HSV ulcers? what if resistant?

A

acyclovir! resistant do ganciclovir

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8
Q

sx of cystitis? MCC?

A

urinary frequency, urgency, burning, and dysuria MCC = E.Coli

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9
Q

Sx of Scabies

A

smalle, burrows in webs of fingers, scrape and magnify

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10
Q

what type of meningitis is associated with…. young kid with petechial rash

A

meningitidis

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11
Q

when should you use rifampin for endocarditis

A

with prostetic valves and staph infection

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12
Q

Tx of herpes encephalitis? what if its resistant?

A
  1. Acyclovir if resistant = Foscarnet
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13
Q

sx of acute heptatitis

A

jaundice, fatigue, weight loss, dark urine caused by increased bilirubin in urine

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14
Q

PEP for HIV

A

ART for a month taht needs to be started within 72 hrs

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15
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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16
Q

tx of leptospirosis

A

ceftriaxone or PCN

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17
Q

tx of nocardia

A

TMP/SMX

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18
Q

which type of hepatitis can be deadly in pregnant women?

A

hepatitis E

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19
Q

how do you ppx for endocarditis for dental/oral procedures? alternative?

A

Amoxicillin If PCN rash: cephalexin If anaphylax: Azithromycin, clarithromycin or clindamycin

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20
Q

tx of nonCNS lyme

A

doxy, amox or cefuroxime

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21
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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22
Q

tx of Epididymo-Orchitis

A

<35yoa = Ceftriaxone and doxy >35 yoa = FQ

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23
Q

initial HIV therapy?

A

2 NRTIs and an Integrase inhibitor

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24
Q

PCP ppx in HIV <200

A

TMP/SMX

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25
Q

For how long is someone with active shingles contagious? How is the virus spread?

A

Patient is contagious until lesions are completely crusted over. Viruses spread via direct contact or rarely aerosolization.

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26
Q

Tx of bacterial meningitis

A

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

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27
Q

sx of Epididymo-Orchitis

A

painful and tender testicle with a *normal position in the scrotum *different from torsion bc torsion would be elevated and horizontal position

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28
Q

common meningitis caused by gram - diplococci

A

neisseria

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29
Q

how do you workup perinephric abscess?

A

aka kidney abscess! *someone with pyelo that didnt resolve within 5-7days. –> Sonogram or CT + drainage + Culture + retreat with ABX

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30
Q

Symptoms of disseminated gonococcal infection?

A

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.

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31
Q

tx of sinusitis?

A

augmentin or doxy for 7-10 days if does not resolve with supportive therapy after 10 days

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32
Q

Treatment of acute, subacute & post herpectic neuralgia/shingles pain?

A

*Acute herpectic neuralgia (<30 days) = NSAIDs, analgesics *Subacute herpectic neuralgia(30 days-4 months) = NSAIDs & analgesics *Post herpectic neuralgia (>4 months) = TCA, gabapentin & pregabalin

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33
Q

When do you need to ppx for endocarditis?

A

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

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34
Q

can kissing transmit HIV?

A

no!

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35
Q

Tx of Urethritis &/or Cervicitis in prego?

A

Ceftriazone IM + Azithromycin *no doxy bc can mess with baby bones + teeth

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36
Q

MCC of culture negative endocarditis?

A

Coxiella

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37
Q

What is Tabes Dorsalis?

A

loss of position and vibratory sense, incontinence and CN abnormalites due to syphilis involving the posterior colums

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38
Q

HACEK ^whats this for? whats it mean? tx?

A

difficult to culture endocarditis: Haemophilus aphrophilus/parainfluenza Actinobacillus Cardiobacterum Eikenella Kingella **tx w/Ceftriaxone

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39
Q

Chancroid v syphilis v lymphogranuloma venereum v HSV ulcers sx?

A

Chancriod = painful ulcers Syphilis = painless ulcers Lymph = painful LYMPH HSV = painless lymph + painful ulcer

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40
Q

endocarditis with MRSA tx

A

Vancomycin alone is enough

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41
Q

tx of plague

A

streptomycin, genta, doxy

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42
Q

tx of actinomyces

A

PCN

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43
Q

tx of CNS lyme

A

ceftriaxone

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44
Q

Tx of Rickettsia meningitis

A

doxycyclin

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45
Q

Acute Prostatitis dx?

A

tender prostate on exam! “boggy” tx just like pyelo just longer!

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46
Q

tx of acute malaria? tx of severe malaria?

A

acute: mefloquinie severe:artemisinins

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47
Q

tx of histoplasmosis, and blastomycosis

A

amphotericin

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48
Q

what is the best initial test for OM? 2nd test? most accurate?

A

Xray > MRI > bone bx

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49
Q

When can postexposure ppx be used for HIV?

A

started <72 hr after exposure, idealy 1-2hrs

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50
Q

what is the MC mechanism of spread of infection to bone?

A

OM caused by direct contiguous spread from teh overlying tissue to the bone.

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51
Q

causes of bloody diarrhea

A

campylobacter, salmonella, vibrio, e.Coli, shigella, yersinia, amebic

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52
Q

Tx of urethritis &/or Cervicitis

A

Ceftriazone IM + Azithromycin 1x and then Doxy for 7days

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53
Q

HIV/AIDS transmission

A

IDU, Sex, Transfusion, Perinatal & breastfeeding, Needle stick

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54
Q

What is Argyll-Robertson Pupil?

A

eyes accommodate to objects but do not respond to light.

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55
Q

Intertrigo Cause? Tx?

A

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)

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56
Q

what is a Jarisch-Herxheimer Reaction?

A

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)

57
Q

best empiric therapy for endocarditis?

A

vancomycin + gentamicin

58
Q

endocarditis with a fungus tx?

A

amphotericin

59
Q

tx of acute prostatitis? chronic?

A
  • If Acute: FQ, IV pip/tazo, 3rd gen cephalosporin for 14 days
  • If Chronic: FQ or Bactrim for 4-6 weeks
60
Q

sx of Pediculosis?

A

aka CRABS larger than scabies, in hair-bearing areas such as the pubic or axilla, visible on the surface

61
Q

tx of Granuloma Inguinale

A

Doxy, TMP/SMX or Azith

62
Q

tx of brucellosis

A

doxy + genta

63
Q

tx of complicated cystitis?

A

7d TMP/SMX or ciprofloxacin

64
Q

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?

A

Candida Endophthalmitis 2/2 central venous cathether for TNP tx: vitrectomy & amphotericin B

65
Q

sx of CHRONIC endocarditis

A

roth spots(retina), janeway lesions(flat, painless in hands and feet), Osler’s nodes(raised, painful, and pea shaped), *splinter hemorrhages(under fingernails) *MC!

66
Q

tx of osteomyelitis?

A

4-6 weeks with vancomycin + pip/tazo untill cultures return

67
Q

which is elevated more AST or ALT in hepatitis/

A

ALT > AST

68
Q

tx of lyme meningitis

A

ceftriaxone

69
Q

whats the most likely dx? how do you work up? pt with fever + new murmer

A

endocarditis = do blood culture first and if postive follow up with echocardiogram to look for vegitations

70
Q

Tx of Lymphogranuloma venereum?

A

Aspirate the bubo then doxy or azith *remember this is chlamydia trachomatis

71
Q

common meningitis caused by gram - pleomorphic, coccobacillary organism

A

Haemophilus

72
Q

best dx test for HIV?

A

ELISA = enzyme linked immunosorbent assay & confirmed with western blot.

73
Q

inpatient treatment for PID

A

Cefoxitin or Cefotetan IV and doxy

74
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

75
Q

Treatment of mononucleosis? Treatment if there is concern for impeding airway obstruction ?

A

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).

76
Q

Treatment for shingles

A

PO valacyclovir q7 days

77
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!

78
Q

tx of aspergillus

A

voriconazole

79
Q

how do you ppx for endocarditis for skin procedures? alternative?

A

cephalexin if allergic: vancomycin

80
Q

Tx of Chancroid?

A

PO azithromycin 1x OR IM ceftriaxone

81
Q

tx of uncomplicated cystitis? what if its resistant?

A

tx Fosfomycin or Nitrofurantoin PO 3d resistant: Ciprofloxacin or Levofloxacin

82
Q

tx of syphillis ulcers?

A

IM PCN

83
Q

tx of pyelonephritis?

A

ciprofloxacin inpatient: ciprofloxacin, ampicillin + gentamicin =these are all excreted in high concentration in urine =)

84
Q

tx of otitis media

A

Amoxicillin, if recurrent = augmentin or cefdinir

85
Q

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?

A

COLONOSCOPY to look for pathology! *bovis and colostridium are associated with colonic pathology and you gotta find it!

86
Q

sx of lyme

A

stage 1: fever + target rash/erythema migrans stage 2:AV heart block, bells palsy stage 3: arthralgias, confusion

87
Q

tx of babesiosis

A

azithromycin or atovaquone

88
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

89
Q

tx of coccidioidomycosis

A

itraconazole

90
Q

tx of Impetigo?

A

topical mupirocin if severe use dicloxacillin or cephalexin

91
Q

common meningitis caused by gram + diplococci

A

pneumococcus

92
Q

tx of cryptococcus meningitis

A

amphotericin & 5FU + fluconazole

93
Q

what type of meningitis is associated with….recently been camping

A

lyme

94
Q

how do you dx infective endocarditis?

A

1st = blood culture and vegitations on heart valve or use Dukes criteria

95
Q

tx of bacterial meningitis in immunocomp pt

A

ceftriaxone+ vancomycin + steroids + AMPICILLIN for listeria coverage

96
Q

tx of otitis externa?

A

topical abx(ofloxacin, ciprofloxacin) + topical hydrocortisone to decrease swelling

97
Q

tx of cellulitis

A

augmentin, cefazolin

98
Q

outpatient treatment for PID

A

Ceftriaxone IM and Doxy oral or cefoxatine

99
Q

tx of erysipelas

A

*caused by GAS = really red skin infection oral docloxacillin or cephalexin

100
Q

tx of Scabies

A

Permethrin > Lindane *same as pediculosis

101
Q

Meningitis vs Encephalisits

A

Meningitis: FND, Papilledema, seizures, AMS, fever, HA, STIFF NECK, photophobia Encephalitis: Fever + CONFUSION

102
Q

PID sx? dx?

A

lower abdominal pain, tenderness, fever, cervical motion tenderness**, leukocytosis 1. PREGO tests 2. cervical culture and NAAT test

103
Q

BIG BEEFY ulcer on genital/perineum? dx?

A

Granuloma Inguinale = Klebsiella Granulomatis *this is BIG & BEEFY

104
Q

topical antifungal tx when hair/scalp or nails are involved?

A

terbinafine, itraconazole, griseofulvin

105
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

106
Q

MAC ppx in HIV <50

A

Azithromycin 1x wk PO

107
Q

tx of tularemia

A

doxy, genta or strepto

108
Q

what type of meningitis is associated with….elderly, neonatal or HIV +

A

listeria

109
Q

if you suspect encephalitis what 2 test do u wanna run?

A

Head CT > PCR of CSF to confirm HSV(MC)

110
Q

What is the best initial treatment for severe diarrhea(blood, fever, abdominal pain, hypotension, tacycardia) if you dnt know the cause?

A

FQ like ciprofloxacin

111
Q

tx of anthrax

A

FQ or Doxy

112
Q

MCC of osteomyelitis?

A

staphylococcus

113
Q

PrEP for HIV

A

ET = Tenofovir & Emtricitabine before exposure and 1 month after exposure

114
Q

tx of bartonella via bite & via scratch

A

bite: augmentin scratch: doxy or azithro

115
Q

common meningitis caused by gram positive bacilli

A

listeria

116
Q

tx of Pediculosis

A

Permethrin > Lindane

117
Q

For how long does the lympadenopathy last for mono?

A

2-3 weeks, if persist longer observe for another 3-4 weeks then send for bx

118
Q

Tx of Necrotizing Fasciitis

A

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

119
Q

dx & tx of orbital cellulitis

A

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

120
Q

treatment of west nile encephalitis

A

dx w/ELISA & treatment is supportive

121
Q

MCC of bacterial meningitis in:

  1. Neonates(0-4 weeks)
  2. Infants(1-23m)
  3. Ages 2-50
  4. Ages 50+
A
  1. Neonates(0-4 weeks) = GBS, Ecoli, Listeria
  2. Infants(1-23m) = S. Pneumo, N. Meningitidis, H. Influ
  3. Ages 2-50 = S. Pneumo, N. Meningitidis
  4. Ages 50+ = S. Pneumo, N. Meningitidis, Listeria
122
Q

Strep vs Mono

which has anterior/posterior lymphadenopathy?

A

Strep = anterior

Mono = posterior

123
Q

How long must a pt avoid contact sports with mono?

How long does lympadenopathy last?

How long does fatigue last?

A

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

124
Q

Presentation of typical vs atypical pneumonia

A

typical = fever, productive cough, dyspnea, pleuritic chest pain

atypical = low grade fever, nonproductive cough, myalgias

125
Q

CURB 65 scoring

A

Confusion, Urea >19, RR>30, BP <90/60, Age >65

1 = outpatient

2= hospitalized

3= consider ICU

4+ = ICU

126
Q

Tx PCP pneumonia?

B-D-glucan level?

A

TMX-SMX or IV pentamidine

BDGlucan level >500U/L

127
Q

Bronchitis sx, dx, tx?

A

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

128
Q

PT who recieved TB vaccine can be tested for TB w/…..

A

Interferon-gamma release assay(IGRA) = no false postive

129
Q

Positive TB Skin Test for HIV pts, Immunocompromised, recent contact with TB, CXR consistent with TV infection

A

>5mm

130
Q

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

A

>10 mm

131
Q

Positive TB Skin Test for low risk of disease with no risk factors for TB

A

>15 mm

132
Q

Common side effect of:

Zidovudine

A

myopahty and bone marrow supression

133
Q

Common side effect of: Didanosine

A

pancreatitis

134
Q

Common side effect of: Abacavir

A

hypersensitivity reaction(fever, chills, dyspnea)

135
Q

Common side effect of: Entricitabine

A

diarrhea, N, headache

136
Q

Common side effect of: Tenofovir

A

renal toxicity

137
Q

Treatment of sporotrichosis

sx?

A

SX: seen in landscapers or gardeners, skin papule w/ulceration & nonpurulent drainage, Lesions long lymph train & lymphadenopathy

TX: 3-6m of Itraconazole

138
Q

Treatment of active TB in prego?

A

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.

Step 3 UW /FA (19 decks)

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