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CB Internal Medicine > Infectious Disease - Academic Week Lecture > Flashcards

Infectious Disease - Academic Week Lecture Flashcards

1
Q

What abx can you use to treat Staphylococcus aureus?

A

Clindamycin
Cloxacillin
Vancomycin
Cephalexin

*all have gram + coverage

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2
Q

What pathogen causes Streptococcal pharyngitis?

A

Streptococcus progenies (Group A strep)

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3
Q

A homeless person presents to the ER with a 3 month hx of recurrent, painful, self draining skin abscesses. What is the most likely pathogen?

A

MRSA

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4
Q

“Grape like clusters”

A

Staphylococci

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5
Q

“chains”

A

Streptococci

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6
Q

Catalase +, coagulase + gram positive cocci

Catalase +, coagulase - gram positive cocci

A

S. aureus

S. epidermidis

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7
Q

Catalase -, Beta hemolytic

A

S. pyrogens (GAS)

S. agalactiae (GBS)

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8
Q

What infections are caused by Staphylococcus aureus?

A

SSTI: impetigo, cellulitis, folliculitis, furnaces, carbuncles

Pneumonia, pulmonary abscesses

Endocarditis, meningitis, joint/bone

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9
Q

What toxin mediated reactions are caused by Staphylococcus aureus?

A

Food poisoning
Scalded Skin Syndrome
Toxic Shock Syndrome

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10
Q

What antibiotics can be used to treat MSSA?

A 
Cloxacillin
Cefazolin (Ancef)
Cephalexin (Reflex)
Vancomycin 
Clindamycin
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11
Q

What antibiotics can be used to treat MRSA?

A 
Vancomycin
TMP/SMX
Clindamycin
Linezolid 
Daptomycin
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12
Q

What infections are caused by Group A Strep?

A

Pharyngitis
Impetigo
Erysipelas
Cellulitis

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13
Q

What toxin mediated reactions are caused by Group A strep?

A

Necrotizing Fasciitis
Scarlet Fever
Toxic Shock Syndrome

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14
Q

What immune mediated diseases are caused by Group A strep?

A

Glomerulonephritis

Rheumatic fever

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15
Q

What is the treatment for Necrotizing Fasciitis?

A

Surgical debridement
IV Pen G
IV Clindamycin
IVIG

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16
Q

What infections can be treated with Pen G?

A

The Big 3:

  1. Streptococci
  2. Neisseria meningitidis
  3. Treponema pallidum (syphilis)

Plus others (C Diff)

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17
Q

What infections can be treated with ampicillin?

A

Pen G coverage +:
Enterococci, Listeria
H Flu
Ecoli, Proteus, Shigella, Salmonella

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18
Q

What infections can be treated with Piperacillin?

A 
Amp coverage +:
Klebsiella, Sebratia, Enterobacter, Citrobacter
Pseudomonas
B. fragilis
MSSA
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19
Q

What infections can be treated with Cloxacillin?

A

Only covers gram +

MSSA (not MRSA)
S. Epidermis
Strep Species

(no gram neg-, no anaerobic)

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20
Q

What bugs cause community acquired pneumonia (CAP)?

A

Streptococcus pneumonia (typical)

Chlamydia (atypicals)
Mycoplasma
Legionella

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21
Q

What is used for out patient treatment of CAP (no modifying factors)?

A

Azithromycin

2nd line: doxy

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22
Q

What is used for out patient treatment of CAP?

COPD, no steroids past 3 months

A

Azithromycin, clarithromycin

2nd line: doxy

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23
Q

What is used for out patient treatment of CAP?

COPS, abs or steroids past 3 months

A

Levofloxacin, moxifloxacin

2nd line: amoxi/clav

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24
Q

Are macrolides good drugs for in or out patient care?

A

Out patient

(bacterial static - bind to 50S ribosomal subunit inhibiting protein synthesis) … wouldn’t use for someone septic

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25
Q

What is Roseola infantum caused by?

A

Human herpesvirus 6 (HHV-6)

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26
Q

How do you treat Herpes Zoster infection?

A

Treat with antivirals within 72 hours of onset:
Acyclovir
Valacyclovir (Vatrex)
Famciclovir (Famvir)

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27
Q

If there are herpes zoster lesions on the tip of the nose, what do you have to worry about?

A

Corneal involvement

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28
Q

What causes athlete’s foot?

A

Dermatophyte Trichophyton rubrum

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29
Q

Erythema infectious (fifth disease or slapped cheek disease) is caused by what

A

Human parvovirus B19

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30
Q

What viruses are DNA viruses?

A 
All the Herpes viruses
HPV
ONLY Hep B
Pox viruses (i.e. molluscum)
Adenoviruses
Parvovirus B19

(rest are RNA - Hep A,C,E, etc)

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31
Q

A 12 year old boy presents with fever and bilateral parotid enlargement, the most likely diagnosis is:

A

MUMPS!

note: patients need isolation, transmitted via droplet nuclei or direct contact

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32
Q

What is the Ontario MMR vaccination schedule?

A

12 months, 4-6 years

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33
Q

What viruses are most commonly involved in pharyngitis?

A

Adenovirus

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34
Q

X-ray lateral neck = thumbprint sign

A

Epiglottitis

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35
Q

What pathogens cause epiglottis?

A

Kids: H. influenza (more nontypel since vaccine); S. pneumonia
Adults: Group A Strep, H flu

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36
Q

What is the treatment for Epiglottis?

A

Maintain airway #1 concern

Ceftriaxone or Cefotxime

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37
Q

8 year old boy presents to the ER with a maculopapular rash associated with some cough, coryza, fever 39.0

Koplik’s spots on palate after day 3

A

Measles

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38
Q

What are complications of Measles?

A 
Otitis media
blindness
pneumonia 
diarrhea
encephalitis 1/1000
death 1/1000
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39
Q

What kind of bacteria is Bordetella pertussis?

A

Gram negative coccobacillus

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40
Q

What is the treatment for whooping cough?

A

Azithromycin or clarithromycin (up to 8 weeks into the cough)

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41
Q

Subcutaneous nodule at injury site with associated nodular lymphangitis which appears up to 6 months is seen in:

A

Sporotrichosis

see spreading up lymphatics

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42
Q

Child age 4 presents with fever, unilateral ear pain, bulging tympanic membrane for 24 hrs. What is the #1 cause bacteria?

A

Streptococcus pneumoniae

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43
Q

Treatment for acute otitis media?

A

Amox or amoxi/clav

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44
Q

What is the most common cause of empyema?

A

Pneumococcus (streptococcus) pneumoniae

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45
Q

A 10 year old girl with a new kitten has a large tender lymph node under the right axilla, otherwise well. Dx?

A

Acute bartonella henselae infection

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46
Q

Pathogens for the following cat exposure diseases:

Cat scratch
Cat feces
Cat bite

A

Cat scratch = bartonella
Cat feces = toxoplasmosis
Cat bite = pasturella

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47
Q

An HIV + patient presents with dysphagia and thrush

A

Oral-esophageal candidiasis

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48
Q

What is the txt for oral-esophageal candidiasis?

A

Oral fluconazole

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49
Q

At what CD 4cell count do you start prophylaxis against Pneumocystis jiroveci (carinii) in HIV patients?

A

200 cells/ml

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50
Q

What drug is used for prophylaxis against pneumocystis jiroveci (carinii) in HIV infected patients?

A

Trimethoprim sulfamethoxozole

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51
Q

When should antiretroviral medication begin in asymptomatic HIV patients at? (CD4 count)

A

ANY CD4 count

old cut off was 500 cells/ml

52
Q

A 37 to male IV drug user presents to the ER. The nurse attending suffers a needlestick injury from the patient. Which infection carries a risk of 0.3% overall risk?

53
Q

What is the risk of perinatal HIV transmission in untreated HIV + women?

A

25% overall risk

54
Q

What is the risk of perinatal HIV transmission in treated HIV + women, stating antiretroviral therapy at 14 weeks gestation, compliant with therapy, and maintains an “undetectable viral load”?

55
Q

What is the current antiretroviral treatment standard?

A

3 drugs one pill/day regimen

Ex: Tenofovir + FTC + Elvitegravir

56
Q

How do you determine the prognosis for HIV infected patients?

A

CD4 lymphocyte count and HIV viral load (RNA load)

57
Q

A 34 year old returns from Zaire Africa 4 days ago with new onset fever, sweats, fatigue. What is your course of action?

A

Typhoid fever is possible and therefore he needs blood cultures

58
Q

What common pathogens cause Traveller’s diarrhea?

A

E coli, Salmonella, Cholera

59
Q

What antimicrobial agent causes tendinopathy?

A

Fluoroquinolones

60
Q

What is the difference in coverage between cipro, levo, and moxi?

A

Cipro - excellent gram neg + pseudomonas
Levo - gram neg-, gram + and atypical
Moxi - levo + anaerobic

61
Q

A 67 yo diabetic patient is treated with gentamicin, ceftazidime, and metronidazole for a gangrenous foot infection. She develops acute renal failure 2 weeks into treatment. Why?

A

Amino glycoside nephrotoxicity

62
Q

An elderly women is readmitted to the hospital with frequent loose diarrhea after being hospitalized for pneumonia. What is the most likely cause?

A

Clostridium difficile

63
Q

Pseudomembranous colitis is caused by:

A

Clostridium difficile

64
Q

Clostridium difficile infection is best treated with

A

Metronidazole orally

65
Q

Elderly woman is treated with oral metronidazole for her C Diff and relapses with diarrhea. She presented several times to a walk in over 3 month period and was given repeat courses of metronidazole. What is she complaining of now?

A

Sensory neuropathy

66
Q

What can you give besides metronidazole for relapsing c diff?

67
Q

A 27 yo female has an ESBL E coli urinary tract infection. What does this mean?

A

ESBL: extended spectrum beta-lactamase producing

Organism is resistant to cephalosporins

68
Q

What is the most common cause of peritonsillar cellulitis or abscess?

A

Beta hemolytic streptococci

69
Q

What is the most common cause of Ludwig’s angina?

A

Group A streptococci + anaerobes

70
Q

How do you treat Ludwig’s angina?

A

Pen G + metronidazole or clinda

71
Q

27 year old female presents to ER with a 2 day hx of fever, flank pain, dysuria. Dx?

A

Pyelonephritis

72
Q

What is the number one cause of pyelonephritis?

73
Q

How many days of abx are required for uncomplicated cystitis?

74
Q

What are the organisms that cause acute pyelonephritis?

A 
KEEPS
Klebsiella
E coli
Enterococcus
Proteus
S saphrophyticus
75
Q

What is the treatment for acute pyelonephritis?

A

14 days TMP/SMX or 3rd gen ceph or FQ

76
Q

List Gram Negative Bacilli

A 
Enterobacter (GI tract):
E coli
Shigella
Salmonella
Citrobacter
Klebsiella
Yersinia
Proteus
Morganella
Serrate
Enterobacter

H Flu
Pseudomonas
Legionella
etc.

77
Q

What antibiotics cover PSEUDOMONAS

A 
Cirpo (only oral agent)
Aminoglycosides (tobramycin, gent)
Ceftazidime / Cefipime 
Pip/tazo
Meropenum
Imipenem
78
Q

What antibiotics cover ANAEROBICs:

A 
Metronidazole
Clindamycin
Moxiflox
Amax/Clav (clavulin)
Cefoxitin/ Cefotetan
Pip/tazo
Meropenum
Imipenum
79
Q

Does a positive mantoux test mean a patient has active TB?

80
Q

Isoniazid hepatotoxicity occurs in what percentage of patients?

A

1-2% of patients in general

2% over the age of 50

81
Q

What are the side effects of Isoniazid?

A

Central nervous system too
Peripheral neuropathy
Hepatotoxicity
Jaundice/ skin rash

82
Q

What is the overall lifetime risk of developing reactivated TB in a patient with untreated latent TB?

83
Q

A hospitalized patient with active pulmonary TB and coughing requires which infection control measure?

A

Negative pressure ventilation

84
Q

What is the difference in treatment between active and latent TB?

A

Latent: Isoniazid (INH) + Vit B6 x 9 months

Active: add
Rifampin x 9-12 mo
Pyrazinmide x 2 mo

85
Q

A 26 yo female reports vaginal discharge and lower abdominal pain over the last few days. Examination reveals much-purulent endocervical discharge and gram stain revealing NO organisms. Dx?

A

Chlamydia trachomatis (doesn’t gram stain, lives IN cells)

86
Q

What is the best way to dx syphilis?

A

Serologically

87
Q

A 22 yo sexually active male presents with urethral discharge and a urine specimen for N gonorrhoea by NAAT is +.
Treatment?

A

Ceftriaxone 250mg IM x 2dose + Azithro 1 gm PO X 1 dose

88
Q

Txt for chlamydia

A

Doxy 100mg PO BID x 7 days
or
Azithro 1gm PO x1

89
Q

Txt for HPV

A

Imiquimod 3x/wk
Cryotherapy
Excision/ laser

90
Q

Txt for treponema pallidum

A

Benzathine Penicillin

91
Q

Txt Herpes

A

Acyclovir 200 mg 5x/d for 5 days

92
Q

With virus is associated with a hepatoma?

93
Q

Close personal contacts of patients with HEP A should receive:

A

Gamma globulin

94
Q

Hep A serologies

A

HAV IgM

HAV IgG

95
Q

Hep C serologies

A

Hep C AB

Chronically determined by further testing for Hep C RNA level

96
Q

Hep B serologies

A

Hep B AB = past infection or immunization

Anti-Hbc = IgM + (acute infection)
= IgG + (past infection)

HBsAg = acute HBV or chronic carrier
HBeAg = chronic active Hep B
97
Q

A patient presents with diffuse erythema, pain, and warmth of the lower leg with associated intermittent fever. Txt?

A

Want to cover Gram + (staph and strep)

IV Cefazolin

98
Q

Skin and soft tissue infection:

Txt for mild, uncomplicated

A

Cloxacillin, cephazolin, or clinda (pen allergy)

99
Q

SSTI in diabetic

A

Add gram neg and anaerobic coverage

100
Q

SSTI in IV drug use

A

MRSA (vanco)

101
Q

SSTI nec fasc

A

Cephazolin or Pen + Clinda

102
Q

An 18 yo previously healthy male presents to ER with a one day hx of headache, fever, photophobia. Empiric txt for bacterial meningitis?

A

IV Ceftriaxone

103
Q

Meningitis: gram+ diplococci

A

Streptococcus pneumo

104
Q

Meningitis: gram neg- diplococci

A

N. meningitidis

105
Q

What drug should you add if you suspect Listeria in meningitis?

A

Ampicillin IV

106
Q

Organisms for acute meningitis in neonates and <2mon

A

Ecoli
GBS
Listeria

107
Q

Organisms for acute meningitis < 10yrs

A

Viral
H flu
S pneumo
Meningococci

108
Q

Organisms for acute meningitis in adults

A

Viral
S pneumo
Meningococci

109
Q

Organisms for acute meningitis elderly

A

S pneumo
Gram neg- baci
Listeria

110
Q

A 50 yo male presents with sudden onset of non bloody watery diarrhea 5 days after returning home from Mexico. dx?

A

1 cause of travellers diarrhea

Enterotoxigenic E. Coli

111
Q

Treatment for Enterotoxigenic E. Coli

A

Levofloxacin
Ciprofloxacin
TMP/SMX

112
Q

IF travellers diarrhea lasts >14 days consider

113
Q

What organisms cause bloody diarrhea (invasive, inflam)

A 
Campylobacter jejuni
Shigella
Salmonella sp
Yersinia
E Coli 0157:H7
114
Q

What organisms cause non bloody diarrhea

A

Enterotoxigenic E Coli
Vibrio cholera
S aureus
C Diff

115
Q

What are parasitic causes of diarrhea?

A 
Entamoeba histolytic (amebiasis) 
txt with metronidazole/ iodoquinol if invasive (liver abscess) 
Guardia lamblia (bever fever) 
txt with metronidazole

Cryptosporidium
txt supportive

116
Q

What viruses cause diarrhea?

A

Rotavirus

Norovirus

117
Q

A 2yo female presents with vaginal and perianal pruritis over the last 1 week. Symptoms are transient and usually nocturnal. Dx?

A

Enterobius vermicularis (pinworms)

118
Q

A 45 yo male from Northern Ontario was investigated for vague RUQ and RLL discomfort. CXR revealed a multiloculated just in the right lower lung and abdo u/s revealed a large cast with septate internal structures. The patient has extensive involvement with wild animals and dogs. Dx?

A

Echinococcus granulosus

dog pinworm - makes cysts in liver, lungs

119
Q

A 60yo male with long standing OA of his knees presents with an acutely inflamed, swollen, painful right knee with difficulty weight bearing. Septic arthritis - what is the route of infection?

A

Hematogenous

120
Q

Common causes of septic arthritis?

A

S. aureus

N. gonorrhoea (75% in sexually active)

121
Q

How do you make the dx of septic arthritis?

A

Arthrocentisis

122
Q

Txt for septic arthritis?

A

Ceftriaxone + Clinda (empiric) min 4 weeks if native joint

123
Q

Erythema chronicum migrant is associated with

A

Lyme disease

124
Q

How do you dx Lyme disease

125
Q

Txt Lyme disease

A

Stage 1: Doxy 21 days

Stage 2,3: Ceftriaxone 2-4 weeks

CB Internal Medicine (12 decks)

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