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Infectious Disease and HEENT > Infectious Disease Exam 1 Cards > Flashcards

Infectious Disease Exam 1 Cards Flashcards

1
Q

5 Types of Leukocytes measured in a differential CBC

A

Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils

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2
Q

3 Granulocytes

A

Neutrophils, Basophils, Eosinophils

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3
Q

2 Agranulocytes

A

Lymphocytes, Monocytes

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4
Q

WBCs from most to least abundant (Hint: Never…..)

A

Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils (Never Let Monkeys Eat Bananas)

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5
Q

Neutrophil (3 facts)

A

First WBC to arrive, primary defense against bacteria and fungi, Immature neutrophils are called bands and can appear in acute bacterial infection: a left shift

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6
Q

Lymphocytes

A

Common in viral infections and leukemias, B T and NK cells

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7
Q

Monocytes

A

Largest WBCs, can migrate into tissue and are more common in CHRONIC infection

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8
Q

Eosinophils

A

Found in skin, airways and blood. Found in allergic, parasitic, and chronic skin conditions

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9
Q

Basophils

A

Defense in hypersensitivity reactions, release inflammatory mediators

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10
Q

Fishbone CBC from top counter clockwise

A

Hgb, PLT, HCT, WBC

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11
Q

Collecting a urine specimen in Men, Women and Children

A

Collect sample when urine has been in the bladder for only 2-3 hours if possible

Women - Clean Labia, Spread and open to urinate
Men - Clean head of penis, retract foreskin, urinate
Children - Must catheterize if not potty trained, otherwise same

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12
Q

Catching and storing a urine specimen

A

Urinate some into toilet then being collecting until cup is half full, Screw lid on tight, Place in bag in fridge if at home

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13
Q

Normal color of urine

A

Straw yellow color

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14
Q

Interpretation of cloudy urine

A

Consistent with pyuria

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15
Q

Normal odor of urine

A

Absent to mild odor

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16
Q

Interpretation of strong fishy urine odor

A

Consistent with infection

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17
Q

10 items on a urine dipstick test (Hint: 3 for infection, 2 physical properties, 2 Metabolic indicators, 3 indicators of hepatic or renal failure)

A

Infection: Leukocyte esterase, Nitrites, Blood
Physical properties: pH, Specific Gravity
Metabolic Indicators: Glucose, Ketones
Renal/Hepatic Failure: Urobilinogen, Bilirubin, Protein

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18
Q

What do nitrites in the urine indicate

A

Gram negative bacteria are converting nitrates to nitrites, a UTI

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19
Q

What would suggest and inadequate clean catch urine sample?

A

Too many epithelial cells

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20
Q

Indication for KOH or Wet prep microscopy

A

Vaginal, Cervical, or Urethral discharge

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21
Q

What do clue cells indicate?

A

Bacterial Vaginosis

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22
Q

4 things best visualized with wet prep microscopy

A

Epithelial cells, Blood cells, Clue cells, Protozoans

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23
Q

One thing better visualized with KOH prep microscopy

A

Fungal cells

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24
Q

Clue cell

A

Stippled vaginal epithelial cell that indicates the presence of a probable infection

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25
Q

True vs. Pseudohyphae

A

True hyphae are filamentous pseudohyphae occur in unicellular fungi

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26
Q

Positioning for a lumbar puncture

A

Lateral decubitus if pressure measurement is needed, upright position if pressure is not needed

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27
Q

Desirable anatomic location for lumbar puncture

A

L3-L4 space or L4-L5 space

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28
Q

Where to locate the spinous process of L4

A

Line between the posterior superior iliac crests

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29
Q

What does pressure tell us in a lumbar puncture?
3-Increased pressure
2 - decreased pressure

A

Increased pressure can indicate infection, tumor, or intercranial bleeding
Decreased pressure can indicate dehydration or CSF leakage

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30
Q

4 CSF tubes to collect

A

Cell Count and differential
Glucose and protein levels
Gram stain, C&S
Other

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31
Q

Normal CSF fluid color

A

Clear and colorless

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32
Q

Indication of Cloudy or Xanthochromic CSF

A

Cloudy or Turbid = Infection
Xanthochromia = Bleeding

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33
Q

Indication of increased CSF viscosity

A

Indicates and infection or malignancy

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34
Q

What do RBCs in a spinal tap indicate
Bleeding or WHAT??

A

Bleeding or a traumatic tap

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35
Q

Normal CFS WBC count in adults and neonates

A

less than 5 in adults, less than 30 in neonates

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36
Q

Normal and abnormal CSF Glucose and protein

A

50-75 mg glucose/dL, CSF:serum ratio should be .6
Less than 40 or ratio less than .4 indicates infection or malignancy

Normally should be NO protein (indicates infection, malignancies, autoimmune disease)

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37
Q

3 additional CSF tests and what they mean

A

Lactic acid - elevated with bacterial or fungal infection
LDH - Elevated with bacterial infection and with leukemia
CRP - Elevated with inflammation, markedly with infection

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38
Q

Normal CSF pressure

A

80-200 mmH2O

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39
Q

Complications of a Lumbar puncture (6)

A

Headache, Traumatic tap, Dry tap, Infection, Hemorrhage, Cerebral herniation

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40
Q

Transudate

A

Clear fluid most commonly caused by CHF or cirrhosis

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41
Q

Exudate

A

Non-clear fluid caused by injury or inflammation

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42
Q

Lights criteria to determine exudate v. transudate

A

If one of these exist the sample is likely exudative
Pleural fluid protein:Serum protein ration >.5
Pleural fluid LDH:Serum LDH >.6
Pleural fluid is >.6 or 2/3 times the normal upper limit for serum LDH

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43
Q

What does milky pleural fluid point to potentially

A

Lymphatic system involvement

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44
Q

What does reddish pleural fluid potentially point to?

A

Presence of blood

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45
Q

What might cloudy, thick, pleural exudate indicate

A

Presence of microorganisms or WBCs

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46
Q

What do decreased pleural fluid glucose levels indicate

A

Infection or malignancy if pH is also decreased

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47
Q

What do increased pleural fluid lactate levels indicate

A

Infectious pleuritis

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48
Q

What do increased amylase levels in pleural fluid indicate (3)

A

Pancreatitis, Esophageal rupture or malignancy

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49
Q

What do increased triglyceride levels in pleural fluid indicate

A

Lymphatic system involvement

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50
Q

When would we use pericardiocentesis

A

To diagnose the cause of pericarditis or pericardial effusion

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51
Q

Technique for pericardiocentesis

A

Using a subxiphoid approach insert a long 18-11 gauge needle directed at a 40 degree angle towards the left shoulder. Aspirate as the needle is inserted

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52
Q

Purpose of performing paracentesis

A

Helps diagnose the cause of peritonitis or ascites

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53
Q

5 indications of milk colored peritoneal fluid

A

Malignant tumor, Lymphoma, TB, Parasitic infection, Hepatic cirrhosis

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54
Q

6 indications of cloudy or turbid peritoneal fluid

A

Peritonitis, Primary bacterial infection, Perforated bowel, appendicitis, pancreatitis, strangulated or infarcted bowel

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55
Q

3 causes of a blood peritoneal tap

A

Benign or malignant tumor, Hemorrhagic pancreatitis, perforated ulcer

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56
Q

Cocci that signal primary vs. secondary peritonitis

A

Gram + means primary
Gram - means secondary

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57
Q

RBC count cutoff for peritoneal malignancy

A

greater than 100 per microliter

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58
Q

RBC count cutoff for intra-abdominal trauma

A

greater than 100,000 per microliter

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59
Q

Abnormal white cell count for peritoneal fluid

A

greater than 300 per microliter

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60
Q

Interpretation of elevated triglyceride levels in peritoneal fluid

A

Malignant tumor, lymphoma, TB, Parasitic infection, cirrhosis

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61
Q

Abnormal protein level for peritoneal fluid and the interpretation thereof

A

Greater than 4 g/dL
TB and malignancy

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62
Q

Abnormal level for peritoneal fluid glucose and the interpretation thereof

A

Less than 6 mg/dL
TB and malignancy

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63
Q

Abnormal amylase threshhold for peritoneal fluid and the interpretation thereof

A

Greater than 50% serum level
Pancreatitis, pancreatic pseudocyst, pancreatic trauma, intestinal strangulation

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64
Q

Indication of increased alkaline phosphatase in the peritoneal fluid

A

Small bowel perforation and strangulation

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65
Q

4 symptoms that indicate for a potential arthrocentesis

A

Joint pain, joint swelling, Erythema, Warmth

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66
Q

Indication of yellow or green synovial fluid

A

Inflammatory or infectous

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67
Q

Indication of red, rusty or brown synovial fluid

A

Fresh or old blood

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68
Q

Indication of turbid/opaque synovial fluid

A

Abnormally large numbers of cells

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69
Q

Indication of string like synovial fluid

A

NORMAL

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70
Q

Indication of increased viscosity synovial fluid

A

Septic arthritis

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71
Q

Indication of decreased viscosity synovial fluid

A

Inflammation

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72
Q

4 diagnostic tests that can be performed on synovial fluid (Hint 3 for infection)

A

Crystal analysis, White cell count with differential, Gram stain, Bacterial culture and sensitivity

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73
Q

4 indications for a chest X-ray

A

Dyspnea, Cough, Fever, Pleuritic chest pain

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74
Q

5 things to look for on a chest X-ray

A

Consolidation, infiltrates, cavitations, nodules, effusions

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75
Q

What do patchy lungs on an X-ray indicate

A

Pulmonary edema

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76
Q

What and X-ray does and does not tell you

A

Can give clues to the causative organism but is not definitive. Luckily you may not need to know the exact organism to treat

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77
Q

CT vs. MRI scanning

A

CT
Fast, Sees bone, Allows for contrast

MRI
Take longer, No metal, Contrast, Shows tissues

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78
Q

Difference between Gram negative and Gram Positive Bacteria
Peptidoglycan and Stain color

A

Gram positive HAVE peptidoglycan and stain PURPLE
Gram negative LACK peptidoglycan and Pinkish red with the counterstain

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79
Q

Steps for a gram stain

A

1.Add crystal violet
2.Add iodine
3. Rinse with ethyl alcohol
4.Counterstain with Safranin Red

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80
Q

Gram stain of atypicals

A

Typically do not stain

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81
Q

Gram Positive Cocci (3)

A

Streptococcus (chains) Staphylococcus (clusters) Enterococcus

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82
Q

Gram positive rods (5)

A

Corynebacterium, Clostridium, Bacillus, Lactobacillus, Listeria

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83
Q

Gram Negative Cocci (3)

A

Acinetobacter, Moraxella, Neisseria

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84
Q

If you are starting on antibiotics when is the BEST time to take a culture

A

BEFORE giving any antibiotics

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85
Q

Blood culture method and interpretation

A

Must take two samples from two locations. If only one is positive contamination may have occured

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86
Q

3 indications for a wound culture

A

Drainage of fluid or puss, Heat redness swelling or tenderness at the sight, Wound is slow to heal

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87
Q

3 Indications for a stool sample

A

Diarrhea lasting more than a few days, Ingestion of suspected contaminated foods, Recent travel outside of the US

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88
Q

What should you order if you suspect GI parasites?

A

A stool for ova and parasites test, not just a stool sample

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89
Q

Most common UTI pathogen

A

E. Coli

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90
Q

Diagnostic criteria for a UTI

A

Greater than 100,000 colonies of a single bacteria

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91
Q

When would you order a sputum culture

A

When you suspect and infection in their lungs

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92
Q

3 Methods of sputum collection

A

Patient produced
Aerosol induced
Nasogastric

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93
Q

Causative agents of the following sputum findings:
Rust colored
Yellow/Green
Green
Currant Jelly
Bloody
Foul Smelling
Thin/Scant

A

Rust colored - Strep. pneumo
Yellow/Green - H. flu
Green - Pseudomonas
Currant Jelly - Klebsiella
Bloody - Tuberculosis
Foul Smelling - Anaerobes
Thin/Scant - Atypicals

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94
Q

Requirements for Sputum TB testing

A

Acid Fast testing: requires 3 separate sputum samples of 12 weeks for a definitive diagnosis

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95
Q

Sputum testing for fungal and atypicals

A

Fungal - Often need a biopsy or serum test

Atypical - Don’t grow on ordinary sputum culture media

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96
Q

How to proceed after a rapid strep test

A

If positive, no further testing needed

If negative, obtain a culture

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97
Q

Five conditions for which strep testing is NOT recommended

A

In children under 3 years old
Routine screening of asymptomac exposures
Cough
Runny nose
Mouth Sores

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98
Q

Centor Criteria for strep (6)

A

History of Fever
Tonsilar exudate
Tender anterior cervical adenopathy
Absence of cough
Modified
Under 15
Over 44 (-1)

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99
Q

Centor criteria scores interpretation

A

0-1 No culture, No abx
2-3 Obtain culture, if positive use abx
4-5 Treat empirically with Abx

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100
Q

3 Pathogens you can detect with a nasal swab

A

Respiratory virus panel
Influenza
Covid

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101
Q

When IS sensitivity testing indicated (4)

A

Unknown or mixed pathogens
Known resistance
Severe infection
Infection not responding

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102
Q

Order for sensitivity testing

A

Should read “Culture and Sensitivity Testing” or C&S

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103
Q

Minimum Inhibitory Concentration

A

Smallest amount of a drug that inhibits the bacteria

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104
Q

When should antibiotic treatment be initiated in relation to a sensitivity test

A

Start it prior to recieving C&S results

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105
Q

Interpretation of susceptibility testing

A

S=Succeptible
I=Intermediate
R=Resistant

Lower numbers are better

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106
Q

What exactly does penicillin bind to?

A

Transpeptidase enzymes which crosslink peptidoglycan chains in gram positive bacteria

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107
Q

4 Classes of Beta Lactams

A

Penicillins, Cephalosporins, Carbapenems, Monobactams

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108
Q

4 Types of antibiotics that act of the cell wall

A

Beta lactams, Vancomycin, Bacitracin, Polymixins

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109
Q

Bactericidal and Bacteriostatic functions of penicillin

A

Cidal - Binding to PBP activates autolytic enzymes that destroy the cell
Static - Binding to PBP makes it so that peptidoglycan synthesis cannot occur and the bacteria cannot divide

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110
Q

3 ways bacteria can become resistant to penicillin

A

Reduce affinity for PBPs
Produce beta lactamases
Overproduce PBPs

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111
Q

Which tastes better? Penicillin or Amoxicillin

A

Amoxicillin

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112
Q

3 anti staphylococcal PCNs

A

Dicloxacillin, Nafcillin, Oxacillin

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113
Q

Indication for anti staphylococcal PCNs

A

Only for skin and soft tissue infections, not effective against MRSA

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114
Q

What is methicillin used for

A

Identifying microbial resistance

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115
Q

2 Aminopenicillins

A

Amoxicillin, Ampicillin

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116
Q

2 First line indications for Aminopenicillins

A

Otitis Media, Endocarditis prophylaxis

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117
Q

3 MCC of otitis media

A

H. flu, M cat, Strep pneumo

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118
Q

2 advantages of aminopenicillins over regular PCNs

A

Higher oral absorption and Longer half life
Superior gram negative coverage

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119
Q

2 PCN beta lactamase inhibitor combinations

A

Amoxicillin/Clavulanic Acid (Augmentin)
Ampicillin/Sulbactam (Unasyn)

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120
Q

First line indications for Augmentin

A

Sinusitis and Pneumonia/COPD exacerbations by
S. pneumo
H. flu
S. Aureus

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121
Q

3 considerations for Amoxicillin/Clavulanic Acid (Augmentin)

A

Increased cost
More GI side effects
Often reserved for more severe/refractory infections

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122
Q

Extended spectrum penicillins description

A

amino PCN with a Urea group added, also cover pseudomonas - PIP and TAZ!

Succeptible to beta lactamase

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123
Q

Indications for PIP and TAZ

A

Severe polymicrobial infections

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124
Q

Only available route for Piperacillin/Tazobactam

A

IV

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125
Q

Rule of thumb for cephalosporin generations

A

The greater the generation the better the Gram - coverag

The lower the generation the better the Gram + coverage

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126
Q

Three 1st generation cephalosporines

A

Cephalexin (Keflex), Cefazolin (Ancef), Cefadroxil (Duricef, Ultracef)

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127
Q

Indications for Cephalexin (Keflex)

A

CAN USE FOR PREGNANCY!!
4x per day - be aware
Minor skin infections, Impetigo, Pharyngitis/OM, E coli cystitis

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128
Q

2 Indications for Cefazolin (Ancef)

A

Clean Surgical Prophylaxis, Serious MSSA infections

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129
Q

Five 2nd generation cephalosporins

A

Cefuroxime (Ceftin)
Cefoxitin (Mefoxin)
Cefotetan (Cefotan)
Cefaclor (Ceclor)
Cefprozil (Cefzil)

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130
Q

Indications for 2nd Gen cephalosporins

A

Cefoxitin/Cefotetan have better Gram - coverage - prophylaxis for dirty surgeries

Cefuroxime, Cefaclor, Cefprozil - 2nd line for pharyngitis, sinusitis, OM, upper and lower respiratory tract infections

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131
Q

Clean v Dirty surgery

A

Clean = Non GI/GU

Dirty = GI/GU

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132
Q

Eight third generation cephalosporins
Know the first TWO and ending of most

A

Ceftriaxone (Rocephin), Cefdinir (Omnicef), Cefditoren (Spectracef), Cefixime (Suprax), Cefotaxime (Claforam), Cefpodoxime (Vantin), Ceftazidime (Fortaz), Ceftibuten (Cedax)

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133
Q

First line indication for Ceftriaxone (Rocephin)

A

Neisseria gonorrhoeae

Also has good pneumococcal coverage
Surgical prophylaxis
Meningitis
PID

IV or IM

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134
Q

Indications for Cefdinir (Omnicef) and Cefixime (Suprax)

A

Second line for upper and lower respiratory tract infections

Also skin and soft tissue but PO only

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135
Q

4th generation cephalosporin

A

Cefepime:

Gram +, -, pseudomonas

Indicated for severe infections and meningitis because of high CSF penetration, IV or IM

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136
Q

5th generation cephalosporin

A

Ceftaroline (Teflaro)

Covers Gram + and VRE

IV only

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137
Q

Monobactam antibiotic

A

Aztreonam (Azactam)

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138
Q

Coverage of Monobactams

A

Good gram - including pseudomonas but no coverage of Gram + or anaerobes

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139
Q

Indications for Monobactams (3)

A

Severe infections of:
E. coli UTI
Gram negative sepsis or bacteremia
CF respiratory infections

3rd or 4th gen cephalosporins have same/better coverage with fewer side effects

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140
Q

4 Carbapenems

A

Imipenem/Cilastatin
Meropenem
Ertapenem
Doripenem

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141
Q

Why is Cilastatin added to Imipenem?

A

To prevent inactivation in the renal tubule of the kidney

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142
Q

Coverage for Carbapenems

A

Broad Spectrum!!
Gram-, Gram+, Anaerobes, Pseudomonas (except for Erta)

NO MRSA COVERAGE

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143
Q

5 Indications for Carbapenems

A

Severe infections of:

Urinary Tract
Meningitis
Peritonitis
Resistant wounds
Osteomyelitis

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144
Q

2 common side effects of beta lactams

A

GI - N/V/D
Vaginal candidiasis

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145
Q

5 potential adverse events from beta lactams

A

Hypersensitivity, C. diff, Nephritis, Anemia, CNS toxicity

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146
Q

5 signs of a TRUE anaphylactic reaction

A

Immediate or within an hour
Hives
Angioedema
Wheezing or SOB
Anaphylaxis

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147
Q

Pharmakokinetics of Beta lactams

A

Minimal liver interaction or CYP450 metabolism
Renal excretion

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148
Q

Monitoring and safety for beta lactams (3)

A

Monitor CBC and Kidney function
Pregnancy category B
Decrease effectiveness of oral contraceptives

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149
Q

2 Glycopeptides

A

Vancomycin and Telvancin

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150
Q

MOA of glycopeptides (Vancomycin)

A

Bactericidally inhibit cell wall synthesis by binding to D-ala D-ala side chains of peptidoglycan

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151
Q

Coverage of Vancomycin

A

Gram positive bacteria including MRSA but no gram negative coverage

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152
Q

First line indications for Vancomycin

A

Inpatient MRSA therapy - IV
Severe or refractory C. diff - PO

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153
Q

Pregnancy category for Vancomycin

A

Oral - B
IV - C

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154
Q

Pharmacokinetics of vancomycin

A

No liver metabolism, renal excretion

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155
Q

Loading dose for Vancomycin

A

Indicated in severe infections 25-30 mg/kg

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156
Q

Monitoring protocol for vancomycin therapy

A

Use AUC for severe MRSA infections (Sepsis, endocarditis, meningitis, etc.)

Use trough levels for all other infections

No monitoring needed for uncomplicated, non-obese, non- renal disease skin/soft tissue infections

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157
Q

Drug of choice for VRE

A

Daptomycin

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158
Q

3 Adverse effects of Vancomycin

A

Red Man Syndrome, Nephrotoxicity, Ototoxicity

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159
Q

3 alternatives for vancomycin

A

Telavancin - almost the same
Daptomycin - VRE but NOT pneumonia
Linezolid - Also VRE

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160
Q

4 aminoglycosides

A

Gentamicin, Tobramycin, Amikacin, Streptomycin

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161
Q

MOA of aminoglycosides

A

Bind to the 30s subunit and inhibit protein synthesis - bactericidal

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162
Q

4 modes of resistance to aminoglycosides

A

Ribosomal mutation, Enzymatic destruction, Lack of permeability, Efflux pumps

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163
Q

Indications for Aminoglycosides (2)

A

Gram negative and M. tuberculosis

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164
Q

3 Black box warnings for aminoglycosides

A

Ototoxicity, Nephrotoxicity, Neuromuscular paralysis

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165
Q

Most frequent combination with aminoglycosides

A

Penicillin (for G+ coverage) Ampicillin/Gentamicin

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166
Q

Pregnancy category for aminoglycosides

A

D

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167
Q

3 Tetracyclines

A

Tetracycline, Doxycycline, Minocycline

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168
Q

MOA of tetracyclines

A

BacterioSTATIC bind to the 30s subunit and block RNA

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169
Q

2 resistance mechanisms for tetracyclines

A

Active efflux of the drug, Enzymatic deactivation

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170
Q

Spectrum of tetracyclines

A

MRSA, G+, G-, ATYPICALS

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171
Q

First line and additional treatment indications for tetracyclines (4&2)

A

First Line: Lyme, Rocky Mountain Spotted Fever, Cholera, Acne
Additional: Chlamydia, Empiric CAP

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172
Q

Tetracycline contraindications

A

Pregnancy
Absolute in 8-9 y/o children (teeth staining)
Relative in 13 y/o children

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173
Q

Tetracycline contraindications

A

Pregnancy (long bone growth and teeth coloration)
Absolute in 8-9 y/o children (teeth staining)
Relative in 13 y/o children

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174
Q

PK of Tetracyclines

A

Hepatic metabolism excreted renally and hepatically

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175
Q

2 things that interfere with tetracycline absorption

A

Antacids and TUMS

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176
Q

5 adverse effects of tetracyclines

A

GI, Hepatotoxicity, Photosensitivity, Vertigo (minocycline), Candida or C diff infections

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177
Q

3 macrolides

A

Azithromycin (Zithromax), Erythromycin, Clarithromycin (Biaxin)

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178
Q

MOA of macrolides

A

Bacteriostatic - inhibits protein synthesis and ability to replicate by binding to 50s subunit

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179
Q

3 methods of macrolide resistance

A

50s subunit modification
Efflux pumps
Degradation enzymes

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180
Q

Macrolide spectrum (6 bacteria)

A

DO NOT CROSS BBB

Atypicals, Mcat, H flu, Legionella, S&S, Diptheria

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181
Q

First line indications for macrolides (5)

Second line (2)

A

Community Acquired Pneaumonia, Chlamydia, Legionella, Diptheria, COPD

Second line:
OM, pharyngitis

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182
Q

PK for macrolides

A

CYP 450 inhibitor
Primarily bile eliminated

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183
Q

4 adverse effects of macrolides

A

GI - N/D
Hepatotoxicity
Pronged QT
Ototoxicity

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184
Q

MOA of clindamycin

A

50s subunit inhibition

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185
Q

Clindamycin spectrum

A

Gram+ with some MRSA and Anaerobes

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186
Q

4 clindamycin indications (Conditions not bacteria)

A

Oral abscess, endocarditis prophylaxis, Bacterial vaginosis, Skin/soft tissue infections

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187
Q

Clindamysin 3 side effects

A

Diarrhea, Rash, Nausea

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188
Q

Clindamycin pregnancy category

A

Category B

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189
Q

Clindmycin Black Box Warning

A

Pseudomembranous colitis (C. Diff)

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190
Q

3 Quinolones

A

Ciprofloxacin, Levofloxacin, Moxifloxacin

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191
Q

MOA of Quinolones

A

Bactericidal - Inhibit DNA gyrase and Topoisomerase IV

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192
Q

3 mechanisms of resistance to quinolones

A

Decreased permeability, Efflux pump, Enzyme mutation

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193
Q

Spectrum of Quinolones

A

More gram negative than gram positive although Cipro has the worst Gram negative coverage

G+ = Strep and MSSA
Anaerobes = Moraxella
G - = H. flu, M cat, Legionella, Salmonella, Shigella, C. jejuni, Vibrio, E. coli, Psuedomonas

Increasing E. coli and Pseudomonas resistance

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194
Q

First line treatment indications for quinolones

A

Otitis EXTERNA - cipro/levo
Pyelonephritis
Prostatitis
Infectious diarrhea
Anthrax

Cipro for belly button down, Levo and Moxi for belly button up

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195
Q

Quinolones Black Box Warning

A

Tendinitis, Tendon Rupture

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196
Q

5 side effects of quinolones

A

Lowers seizure threshold, Nephrotoxic, Glucose alterations, Photosensitivity, C. diff

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197
Q

Bactrim is….

A

Trimethoprim/Sulfamethoxazole

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198
Q

Mechanism of Bactrim

A

Trimethoprim is a folate reductase inhibitor

Sulfamethoxazole is a folate synthesis inhibitor

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199
Q

5 coverages of Bactrim

A

Pneumocystis Jiroveci
Listeriosis
Prostate and UTI
GI infections
Respiratory infections

Mostly Gram negative coverage

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200
Q

First line indications for Bactrim (3)

A

Outpatient MRSA (use Clindamycin if allergic)
UTI/Cystitis
P. Jiroveci prophylaxis

Can also be good for legionella though not first line

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201
Q

4 adverse reactions of bactrim

A

Megaloblastic anemia
GI N/V/D
Photosensitivity
Hepatotoxicity

Pregnancy C

202
Q

Combo that makes up nitrofurantoin

A

Macrobid/macrodantin

203
Q

MOA and use of Nitrofurantoin

A

Inhibit bacterial enzymes and damages DNA - Only active in the urine and thus useful for UTIs

204
Q

2 Cautions for Nitrofurantoin

A

Avoid in pregnancy
Do not use in severe renal impairment

205
Q

MOA of metronidazole (Flagyl)

A

Disrupts microbial DNA

206
Q

Spectrum of Metronidazole (4 anaerobes, 3 protozoans)

A

Anaerobes - Clostridium, Bacteroides, Fusobacterium, Gardenerella
Protozoans - Trichomonas, Giardia, E. Histolytica

207
Q

5 first line treatments for metronidazole

A

Trichamonas, Bacterial Vaginosis, C. diff, Amebiasis, Giardiasis

208
Q

5 Cautions/Adverse effects for Metronidazole (Flagyl)

A

GI distress
Metallic taste
Disulfiram like reaction
Severe Liver disease or anemias
DO not take with alcohol

Black box warning for cancer in mice and rats

209
Q

Silver sulfadiazine (silvadine)

A

Folate synthesis inhibitor with the same ingredient as bactrim. Topical cream for burns QD or BID

210
Q

Sulfacetamide

A

Folate synthesis inhibitor with sulfa ingredient of bactrim and ingredient similar to trimethoprim. Solution or ointment for opthalmic infections

211
Q

Pyrimethamine (Daraprim)

A

Antiparasite/Antimalarial Folate reductase inhibitor, used to treat malaria and toxoplasmosis

212
Q

Bacitracin - What it is, What it targets, How it is used

A

Polypeptide active against gram negative bacteria, limited to topical use dues to nephrotoxicity - Like trimethoprim

213
Q

Polymixin B

A

Polypeptide with Gram negative coverage. Usually used for opthalmic drops especially pseudomonas

Parenteral forms reserved for highly resistant gram negative organisms

214
Q

Chloramphenicol

A

Misc. synthetic antibiotic with broad spectrum and many side effects - last resort. Hematologic toxicity even when topical. IV or opthalmic solution

215
Q

Mupirocin (Bactroban)

A

Bactericidal antibiotic tat inhibits RNA and protein synthesis. Gram positive activity including MRSA. MC use for Impetigo and in tandem with chorohexidine to decolonize MRSA carriers

216
Q

4 species of Staph and what they are known for

A

S. aureus - most pathogenic
S. epidermis - Skin and hospital acquired
S. saprophyticus - UTI
S. lugdunensis - Foreign body, prosthetic infections

217
Q

Coagulase positive staph species

A

S. aureus only

218
Q

Mode of transmission and related diseases of Staphylococcus

A

Direct tissue invasion MC
Also exotoxin production

Skin and soft tissue, Septic arthritis, Pneumonia, Endo carditis

Food poisoning and toxic shock syndrome

219
Q

Treatment for MRSA skin infections

A

Drain Abcess
Empiric antibiotics and then match to culture
Use Cephalexin (Keflex), or Dicloxacillin for low risk MRSA
Clindamycin, Doxy/Monocycline, or Bactrim for high risk MRSA

220
Q

Treatment for inpatient Staphylococcus infection

A

First line - Vancomycin IV

Clindamycin, Cefazolin, Nafcillin/Oxacillin also options

221
Q

Detection and treatment of Staphylococcal osteomyelitis

A

Confirm with X-ray
Start with Vanc. and 3rd or 4th generation cephalosporin then taper to culture and susceptibility

222
Q

3 potential causes of TSS

A

Tampon use, Nasopharyngeal packing, Direct wound innoculation

223
Q

Presentation of TSS 7 symptoms

A

Sudden onset fever, myalgia, and N/V, Erythrematous rash that desquamates, thrombocytopenia, renal impairment syncope and shock may follow

224
Q

Treatment of toxic shock syndrome

A

Admit, Support (IV fluids, etc.), Debride/decontaminate, Empiric antibiotics (vanc and clinda, and choose 1 pip/taz or cefepime or carbapenem)

225
Q

Presentation of scalded skin syndrome

A

Most common in infants and young children - transmitted via birth canal or from adult carriers and caused by S. aureus toxins

Widespread bullae and sloughing can lead to sepsis and electrolyte abnormalities

226
Q

Diagnosis and treatment of Scalded Skin syndrome

A

Diagnosis made clinically and confirmed via biopsy and culture

Fluid management and skin care as with ACTUAL burns. Nafcillin or oxacillin for MSSA Vanc. for MRSA

227
Q

Treatment and pathology of coagulase negative staph infections

A

Usually hospital acquired from operations, prosthetics, or catheters. Usually resistant and treated with vancomycin

228
Q

3 types of beta hemolytic strep and what they are known for

A

S. pyogenes (A) - Pharyngitis and Skin infections
S. agalactiae (B) - Vaginal and inestinal flora can cause septic abortion in neonates
S. bovis (D) - Endocarditis (esp. prostethic valve

229
Q

8 common infections of Strep Pyogenes

3 Pharyngeal
3 Skin
2 Systemic

A

Strep throat, Peritonsilar abscess, Scarlet fever

Impetigo, Erysipelas, Cellulitis

Rheumatic fever, Delayed acute glomerulonephritis (can take up to 2 weeks to appear)

230
Q

6 signs of strep pharyngitis

A

Tonsilar hypertrophy with erythema, Tonilar exudates, Beefy red uvula, Palatal petichiae, tender anterior cervical lymphadenopathy, Sandpaper rash

NOTE: strep is the only bacteria that grows in the throat - atypical signs could be strep but you only know by checking the throat

231
Q

3 lines of strep pyogenes treatment

A

PO or IM penicillin (VK or G respectively)

Amoxicillin 2nd line

Cephalosporin if allergic

Azithromycin as a last resort

232
Q

Rash of scarlet fever presentation

A

Diffuse rash with papules that may become petechiae, strawberry tongue, flushed face

233
Q

Presentation of impetigo

A

Focal, vesicular, pustular lesions with a thick honey colored crust and stuck on appearance - can also be S. Aureus

234
Q

6 antibiotics for impetigo 3 for non-MRSA 3 for MRSA

A

Topical muciprocin, cephalexin, dicloxacillin

MRSA - Bactrim, doxycycline, clindamycin

235
Q

Presentation of erysipelas

A

Painful superficial cellulitis with dermal lymphatic involvement that involves the face can also be caused by S. aureus

236
Q

Inpatient and Outpatient Erysipelas

A

Outpatient/ non systemic - Pen VK or amoxicillin first, dicloxacillin cepalexin, clinda erythro secon

Inpatient/ systemic - Vancomycin, Cefazolin, Ceftriaxone, Clinda

237
Q

2 common causes of cellulitis

A

Group A beta hemolytic strep or S. aureus

238
Q

Strep Agalactiae (Group B) and pregnancy
When to test and 4 treatment options

A

Begin routine pregnancy screening at 35th week, treat prophylactically with PCN G or ampicillin if positive test. Not a problem if delivering via C-section

Cefazoline clinda or vanc can also be used

239
Q

2 alpha hemolytic strep

A

S. pneumoniae - Upper and Lower respiratory tract infections

S. viridans - Normal mouth flora, native valve endocarditis

240
Q

2 differential diagnoses to consider in necrotizing fasciitis

A

GABHS or C. perfringens

241
Q

5 diseases caused by Strep pneumo

A

MCC of community acquired pneumonia
Otitis media
Sinusitis
Meningitis
Endocarditis

242
Q

6 symptoms of otitis media

A

Otalgia, hearing loss, fever, nausea, vomiting, irritability

243
Q

3 risk factors for pediatric otitis media

A

Smoking in the household, family history, bottle feeding

244
Q

3 signs of otitis media

A

Erythromatous/bulging TM, Lack of light reflex and motility, Otorrhea with TM rupture

Can also do a tympanogram but not always necessary

245
Q

First, Second and THird line treatments for OM

A

Start with amoxicillin, then use Augmentin/Omnicef(straight to this if TRUE PCN allergy)
THEN Rocefin and refer to an ENT

246
Q

Progression of acute sinusitis

A

Usually starts as viral and then develops a secondary bacterial infection

247
Q

Diagnostics for acute sinusitis

A

Green snot DOES NOT indicate bacteria

Wait 10-14 days and look for other signs

Can be caused by OM bacteria OR S. aureus

248
Q

Most common cause of community acquired pneumonia

A

Strep Pneumo

249
Q

6 Signs and Symptoms of Strep Pneumo CAP

A

High fever w/ chills
Early onset rigors (shaking chill)
Productive cough with rust colored sputum
SOB
Pleuritic chest pain
Crackles in affected lobe

250
Q

Diagnosis for Strep Pneumo CAP

A

Lobar consolidation with some effusion
Only obtain a sputum culture if comorbidities are present

251
Q

Outpatient Treatment for S. pneumo CAP 3 with comorbidities 3 without

A

Without comorbidities:
Amoxicillin
Doxycycline
Azithromycin (Zithromax) if less than 25% resistance in the area

With COPD/comorbidities
Levofloxacin
Augmentin
Cephalosporin and Zmax or Doxy

252
Q

Inpatient treatment for S. pneumo CAP

A

Levofloxacin OR macrolide (ie. Zmax) and beta lactam (amoxicillin or ceftrioxone)

253
Q

Two diagnostic tools to determine whether or not to admit CAP diagnosed patient and what tests you need for each

A

CURB-65 Need BMP
PSI - Need ABG

2+ Consider admittance
3+ Definitely admit

254
Q

MCC causitive organism for Meningitis based on ages
Under 3 months
3 months to 10 years
10-19 years
Adult
Elderly

A

Under 3 months - Group B strep
3 months to 10 years - S. pneumo
10-19 years - Neisseria Meningitis, S areus in penetrating head trauma, H. flu (rare in US)
Adult - S pneumo, S. Areus, Nmeningitidis (less common
Elderly - S. pneumo, S. areus, Listeria

Consider Listeria or Pseudomonas if immune compromised

255
Q

2 types of enterococcus where they are found and 5 things they can cause

A

E. faecalis and E. faecium

Normal intestinal flora

Cause: UTI, Bacteremia, Endocarditis, Intra-abdominal infections, Wound infections

256
Q

Treatment for Enterococcus infections

Endocarditis

Skin/Wound/UTI

VRE

A

Endocarditis - Ampicillin and Gentamicin

Skin/wound/UTI - Ampicillin or vancomycin

For VRE - Linezolid or daptomycin

257
Q

3 Gram positive rods

A

Bacillus, Listeria, Corynebacterium

258
Q

2 species of bacillus

A

B. anthracis and B. cereus

259
Q

Incubation and 3 signs of Cutaneous anthrax

A

Occurs within 2 weeks of toxin exposure

PAINLESS black eschar
Regional adenopathy
Fever, malaise, headache

260
Q

Cause and 5 symptoms of GI anthrax

A

Inadequately cooked meat of infected animals

Fever, N/V/D w/ blood
GI bleed
Ulcerations of GI tract
Bowel obstruction and perforation

261
Q

Cause and 5 symptoms of Inhaled Anthrax

A

Inhalation of anthrax spores

Insidious onset of flu like symptoms
Chest pain and respiratory distress
Hypoxemia and shock
Pleural effusion
Septicemia and meningitis

262
Q

Diagnosis (4) and Treatment for Anthrax infection

A

Culture/Biopsy, Gram Stain, Nasal Swab, CXR

IV cipro 7-10 days cutaneous 60 days for inhaled

Doxycycline as alternate tx

263
Q

2 types of illness caused by B. cereus toxins

A

Diarrheal or Emetic, occurs within 1-10 hours of exposure. Usually from leftover (ie. rice) Fluids and rest are recommended tx

264
Q

2 pregnancy risks from listeria monocytogenes

A

Spontaneous abortion and Neonatal meningitis

265
Q

4 general aspects of literiosis presentation

A

Bacteremia, Meningitis, Dermatitis, Oculoglandular symptoms

266
Q

Dx and Tx for Listeria

A

Culture of Blood and CSF
Ampicillin and Gentamicin OR amoxicillin OUTPATIENT

267
Q

Presentation of pharyngeal and nasal Diphtheria

A

Pharyngeal - Gray membranous covering of the tonsils and pharynx. Then sore throat and malaise followed by toxemia and prostration

Nasal - Nasal Discharge

Can later spread to heart, nervous system and kidneys

268
Q

3 treatment steps for Corynebacterium diptheriae

A

Diphtheria equine antitoxin
PCN or erythromycin
Treat contacts with erythromycin

269
Q

3 Gram negative cocci

A

Acinetobacter, Moraxella, Neisseria

270
Q

3 things to know about acinetobacter

A

Opportunistic pathogen
Can affect any organ system (respiratory most common)
Can survive on dry surfaces for up to a month

271
Q

3 conditions caused by Moraxella catarrhalis

A

OM, Sinusitis, COPD exacerbations

272
Q

2 species of Neisseria

A

N. meningitidis and N. gonorrheae

273
Q

Characteristics of N. meningitidis

A

40% of adults are carriers and spread it person to person - most common in military camps, schools, daycares, and college dorms. Mostly in children, adolescents, and young adults

274
Q

6 signs/symptoms of N. meningitidis meningitis

A

Fever, HA, Stiff neck
N/V photophobia, lethargy
Change in mental status
Maculopapular rash, petechiae
Positive meningeal signs
Can progress to organ failure and shock upon meningococcemia

275
Q

Diagnosis and Tx for Neisseria meningitis

A

Lumbar puncture and CSF analysis with Blood culture

PCN G if known susceptibility or ceftriaxone (Rocephin) - continue therapy until patient is afebrile for 5 days

Prophylax close contacts

276
Q

CDC recommendation for Meningococcal vaccine

A

vaccinate at 11-12 and boost at 16

277
Q

7 disease states of Neisseria Gonorrheae

A

Cervicitis/Urethritis
PID (Pelvic inflammatory disease)
Prostatitis
Disseminated disease
Skin rashes
Septic Arthritis
Newborn conjunctivitis

278
Q

3 cervical presentations of gonorrhea

A

Yellow/green dicharge, Erythromatous, Firable (bleeds easily)

279
Q

Dx and Tx for gonorrhea

A

Gram stain and culture (G- intracellular diplococci)

1 dose of cephtriaxone (rosephin)

Must report to health department

280
Q

Origin and Common Infections of Pseudomonas

A

Found in water and soil
Causes opportunistic infections
OT, UTI, Dermatitis in healthy individuals
Pneumonia, Bacteremia, Sepsis in immune compromised, CF, and Burns

281
Q

4 diseases for which pseudomonas is the no. 1 pathogen

A

Otitis Externa
Corneal ulcers in contact lens wearers
ICU-related pneumonia
Osteochondritis after tennis shoe puncture

282
Q

Disease for which pseudomonas is the number 2 pathogen

A

Nosocomial Pneumonia

283
Q

Disease for which pseudomonas is the no. 3 pathogen

A

Hospital acquired UTIs

284
Q

Unique disease associated with Pseudomonas and its 3 symptoms

A

Folliculitis:

Plaques, papules, and pustules
Pruritus
7-10 day duration

285
Q

Clinical presentation of pseudomonas

A

Most common symptom is fever, depends on site infected UTI, OE, and Respiratory infections most common

286
Q

Inpatient and Outpatient treatment for pseudomonas

A

Outpatient:
Cipro/Levofloxacin (Levaquin)

Inpatient (IV):
Pip/Taz(Zosyn), Ceftazidime (Fortaz), Cefepime(Maxipime), Meropenem, Aztreonam

For Cystic Fibrosis Patients
Tobramycin inhaled

287
Q

4 Gram negative rod respiratory tract illness bacteria

A

B. pertussis
H. flu
Legionella
Klebsiella

288
Q

3 stage presentation of Pertussis

A

Catarrhal - insidious onset with some sneezing/cough
Paroxysmal - worsening cough with “whoops”
Convalescence - Symptoms diminish, cough may persist for some time

289
Q

Diagnosis, Treatment and Prevention of pertussis

A

Diagnosed via nasopharyngeal culture
Treated with azithromycin (bactrim can be backup)
Prevented by vaccine (Tdap)

290
Q

8 diseases that can be caused by H flu (Becomes Pneumonia)

A

Sinusitis
OM
Bronchitis
Epiglottitis
Pneumonia
Cellulitis
Meningitis
Endocarditis

291
Q

What three things is H flu a common cause of and what 1 rare thing is it the number one cause of?

A

Sinusitis, OM, Respiratory

Epiglottitis

292
Q

Source and common patient population of Legionella

A

Often from contaminated water source (ie. a C-PAP or Car wash)
Most common in the immune compromised and those with chronic lung disease

293
Q

Presentation of Legionairre’s disease including CXR
4 Things

A

Scant sputum, pleuritic chest pain, high fever. Patchy infiltrates or consolidation on CXR, use antigen to confirm diagnosis if no organisms on gram stain

294
Q

Treatment and time for legionella

A

Macrolide or floroquinolone 10-14 days or 21 days if immune compromised

295
Q

Typical patient population for Klebsiella infections

A

Immune compromised persons - Alcoholics, Diabetics, HIV

Can cause UTIs and is normal intestinal flora

296
Q

Clinical presentation of Klebsiella 3

A

Severe SOB and pleuritic chest pain
Red currant jelly sputum
Can progress to a lung abscess

297
Q

2 diagnostic tools for klebiella

A

CXR and sputum culture

298
Q

Treatment for Klebsiella

A

Very resistant so susceptibility testing is a must
Empiric treatment with a respiratory fluoroquinolone or Carbapenem

299
Q

5 GI illness gram negative rods

A

Escherichia coli, Campylobacter, Salmonella, Shigella, Vibrio

300
Q

7 symptoms of an E. coli infection

A

4-5 loose watery stools per day
Urgency to defecate
Abdominal cramps
N/V
Fever
Bloating
Dehydration

301
Q

3 treatments for E. coli travelers diarrhea

A

Antimotility agents - not recommended for infants for fever and bloody stool patients
Pepto Bismol - not recommended for pregnant women ASA illness
Cipro 3-5 days for severe, treat dehydration

302
Q

Tenesmus

A

Urgency to defecate but nothing comes out

303
Q

Presentation and treatment for Campylobacter Jejuni

A

One of the most common causes of foodborne illness
Bloody diarrhea, dysentery, cramps, fever, and pain

Treat with ciprofloxacin or Zmax

304
Q

Shigella presentation and treatment
4 symptoms, 2 drugs

A

Abrupt onset of diarrhea often with blood and mucus, pain, tenesmus and systemic symptoms (fever, chiils, malaise) WBCs in stool

Rehydrate patient, cipro or bactrim are common treatments

305
Q

Presentation of Cholera

A

Sudden vluminous stool - gray color without blood or mucus or fecal odor “rice water stool” Diagnose via stool culture

306
Q

Treatment for cholera

A

Hydrate

Tetracycline/Doxycycline
Bactrim
Zmax
Cipro

307
Q

3 non-cholera vibrio infections

A

Parahaemolyticus
Mimicus
Hollisae

308
Q

Presentation and treatment of non-cholera vibrio illnesses

A

Watery diarrhea, tenesmus and abdominal cramping
Cellulitis

Dx with stool culture

Treat with doxy or cipro

309
Q

2 Types of salmonella infection

A

Enteric fever and Acute enterocolitis

309
Q

2 Types of salmonella infection

A

Enteric fever and Acute enterocolitis

310
Q

5 symptoms of typhoid fever

A

Pea soup diarrhea, Rose spots, Fever, positive salmonella culture, exhaustion

311
Q

Treatment for typhoid fever (salmonella typhii)

A

Ciprofloxacin/Levofloxacin
Ceftriaxone
Azithromycin

312
Q

Presentation for salmonella enterocolitis and treatment
3 Symptoms, 4 Treatments

A

Nausea, cramping, ABDOMINAL PAIN , AND DIARRHEA

Do not treat in uncomplicated cases

Cipro, Rocephin, Zmax, or bactrim for serious cases

313
Q

UTI

A

An infections anywhere in the urinary system (urethra, bladder, kidneys, etc.)

314
Q

Pyelonephritis

A

An untreated UTI that has spread to the kidneys and can cause permanent damage

315
Q

MCC and three other species often responsible for a UTI

A

E. coli - MCC

Also consider Klebsiella, Proteus mirabilis, Enterobacter

316
Q

5 treatments for UTI/Uncomplicated cystitis

A

Bactrim 1st line
Nitrofurantoin - increased risk of jaundice in last trimester of pregnancy
Fosfomycin
Cephalexin/Cefdinir along with Bactrim for children and 3rd trimester of pregnancy
Ciprofloxacin (not well studied with pregnancy)

317
Q

3 Treatments for pyelonephritis

A

Cipro
Levofloxacin (Levquin)
Ceftriaxone plus [Bactrim, Augmentin, or Omnicef)

318
Q

Black death “bubo”

A

Name for a massively swollen lymph node characteristic of a Yersinia Pestis infection

319
Q

3 modes of bubonic plague

A

Bubonic
Septicemic
Pneumonic

320
Q

Presentation of bubonic plague

A

Large swollen suppurative lymph nodes
Tachnypnea with productive cough and bloody sputum
Toxicity and comatose state - black plaques on extremities

321
Q

Treatment and prophylaxis for Bubonic plague

A

Begin therapy immediately

Streptomycin, gentamicin, doxycycline or a fluoroquinolone for 10 days. Respiratory isolation

Doxy or cipro for 7 days to contacts for prophylaxis

322
Q

3 vectors of tularemia

A

Rodents, Rabbits, Ticks

323
Q

Presentation of tularemia

A

Most virulent contagious bacteria known (one of)
Fever, HA, prostration, Lymphadenopathy, Papule to ulcer at site of innoculation

324
Q

4 drugs to treat tularemia

A

Streptomycin. Gentamicin, Doxycycline, Fluoroquinolones

325
Q

Threshold for a fever

A

100.4 degrees F or 38 degrees C

326
Q

Definition of Fever of Unknown Origin

A

Fever over 101.9 or 38.3 taken on several occasions that lasts for three weeks and cannot be diagnosed after 1 week of inpatient investigation

327
Q

4 Flavors of FUO

A

Classic FUO
Hospital Acquired FUO
Immunocompromised/neutropenic FUO
HIV-related FUO

328
Q

Best site to take temperatures for fever

A

Oral is possible

Rectal or axillary for infants (need to add 1 to axillary temp generally)

329
Q

4 differential diagnoses for FUO

A

Noninfectious (Vasculitis, Lupus, Granulomatous disorders)
Infectious (TB, Cat scratch, EBV)
Malignant/Neoplastic
Misc (Cirrhosis, Crohn’s, PE)

330
Q

Treatment for FUO

A

Don not treat empirically, collect as much info as possible and treat etiology if determinable. Refer if etiology cannot be determined

331
Q

Criteria for Systemic inflammatory response

A

2 or more of the following:

Fever over 38 degrees C or 100.4 degrees F
Heart Rate over 90 bpm
Resp Rate over 20 bpm
Abnormal WBC count (under 4k over 12k, over 10% bands)
PCO2 less than 32 mmHg

332
Q

4 factors that can contribute to SIRS

A

Ischemia
Inflammation
Trauma
Infection

333
Q

Difference between Bacteremia and Septicemia

A

In bacteremia, bacteria are simply present in the blood at a relatively smaller quantity

In septicemia bacteria are not only present in blood but multiply, produce toxins, and cause systemic symptoms. They cannot easily be cleared by the immune system

334
Q

Most common cause of septicemia

A

Respiratory infection, Gram + bacteria are usually most prevelent

335
Q

qSOFA criteria for sepsis

A

Respirations over 22/min
Altered mentation
Systolic BP under 100 mmHg

Do SOFA score if criteria are met (at least 2)

336
Q

Other notable signs of Sepsis (6)

A

High glucose w/o diabetes
CRP 2 SD above normal
Oliguria - acute
Hyperlactatemia
Thrombocytopenia
Diminished capillary refill with mottling

337
Q

Criteria for sepsis

A

2 SIRS criteria and a confirmed or suspected infection

338
Q

Criteria for severe sepsis

A

Sepsis + Signs of end organ damage, SBP under 90 Lactate over 4 mmol

339
Q

Septic shock signs

A

Severe sepsis with persistent signs of end organ damage, SBP under 90, Lactate over 4mmol

340
Q

Treatment for Sepsis (5)

A

Start abx therapy within 1 hr
Use multiple empiric abx’s
IV fluids
Vasopressors
Central lines

341
Q

General sepsis mortality

A

50-55% when source unknown

342
Q

4 Gram positive anaerobes

A

CAPP

Actinomyces
Clostridia
Peptostreptococcus
Propionibacterium

343
Q

4 Gram negative anaerobes

A

Bacteroides
Fusobacterium
Prevotella
Porphyromonas

344
Q

3 common infections caused by actinomyces

A

Head and Neck infections, Intra-abdominal infections, Aspiration pneumonia

345
Q

2 common infections caused by peptostreptococcus

A

Oral infections and Intra abdominal infections

346
Q

3 Infections under one umbrella caused by propionibacterium

A

Foreign Body infections
- Prosthetic join
- Cardiac device
- Shunts

347
Q

3 common signs of a gram positive anaerobic infection

A

Foul Purulent Abcess
‘Spongy tissue
Necrotic tissue

348
Q

3 CXR signs of gram positive anearobic infection

A

Infiltrates with or without cavitation
Lucency of infiltrates, suggesting tissue necrosis
Abnormal air/fluid levels within circumscribed infiltrate

349
Q

Time required for anaerobic sensitivity testing

A

Can take up to a week

350
Q

Treatment for Gram positive anaerobic infections

A

Drain and debride abcess

for throat and neck - clindamycin, Augmentin, Unasyn
For GI/Pelvic - Moxifloxacin PO OR Ertapenem, ceftriaxone, metronidazole IV

Severe - Imipenem

351
Q

Treatment for a gram positive anaerobic lung abscess (3)

A

Beta lactam with betalactamase inhibitor (ie, ampicillin/sulbactam (Unasyn)
Or carbapenem
Or Clindamycin

352
Q

Treatment for gram positive anaerobe aspiration Out and In patient (2 each)

A

Outpatient ; Augmentin or Doxycycline

Inpatient ; Beta lactam with beta-lactamase inhibitor OR metronidazole with amoxil or PCN-G

353
Q

Gram positive anaerobic prophylaxis for
Dental procedures
Endocarditis
Colorectal sugery

A

Dental procedures PCN or amoxicillin in patients with implants

Endocarditis - Amoxycillin

Colorectal surgery prophylaxis - Metronidazole and a 2 or 3 gen Cephalosporine or Cipro
OR just carbapenems

354
Q

5 Clostridial Infections

A

Perfringens
Sepcium
Tetani
Botulinum
Difficile

355
Q

Three diseases caused by Clostridium perfringens

A

Cellulitis, myositis, clostridial myonecrosis

Typically occurs after an injury that has devitalized tissue

356
Q

5 signs and symptoms of a clostridium perfringens infection

A

Pain, edema, erythema, crepitus from gas formation, foul smell

357
Q

Time to culture for clostridia generally

A

About 6 hours

358
Q

Treatment for clostridial soft tissue infection
3 - One pharm treatment

A

Drainage and debridement
Pip/Taz plus clindamycin
Hyperbaric therapy

359
Q

C. perfringens gastroenteritis

A

Mild gastroenteritis with watery diarrhea. Vomiting and fever not usual. Lasts about 24 hours - self limiting

360
Q

Transmission for C. tetani

A

After injury via wounds or burns, also IV drug use

361
Q

Pathophysiology and incubation of tetanus

A

Causes irreversible muscle contraction at nerve endings, 5-30 day incubation period

362
Q

4 symptoms of tetanus

A

Jaw stiffness, Difficulty swallowing, tonic muscle spasms, Respiratory failure

363
Q

5 elements of care for tetanus

A

Respiratory Care
Drugs for muscle spasms
Tetanus immune globulin within 24 hours
Vaccination
PCN or metronidizole

364
Q

Clinical presentation of botulism

A

Dry mouth, slurred speech, dysphagia, drooping eyelids - leading to respiratory failure

Onset in 18-36 hours preceded by N/V/Cramps

365
Q

Treatment for botulism

A

Respiratory care, NG tube/GI care, Antitoxin

PCN or metronidazole for wound botulism

366
Q

Clinical presentation of C. diff

A

Typically begins 5-10 days after antibiotic use

Diarrhea, watery or bloody stool, abdominal cramping, tenderness and bloating

N/V is rare

367
Q

How does C diff damage the gut?

A

It causes cells to become inflamed and eventually burst

368
Q

C. diff diagnosis

A

Stool sample for toxin, fecal leukocytes, sigmoidoscopy looking for pseudomembranes (if strongly suspected with negative culture), Imaging also an option

369
Q

C. diff treatment

A

Mild to Moderate - Fidaxomicin 200 mg PO BID or vancomycin - 125 mg PO BID

Severe Vanco 125-500
Same Fidaxo
Maybe add metronidazole

Recurrences either of above Q6 500 mg

Resistant - Fecal transplant

370
Q

6 characteristics of a gram negative anaerobic infection

A

Abscess formation with tissue necrosis
Suppurative/purulent
Foul odor of pus or infected tissue
Site of infection near where flora reside
Often polymicrobial
Can lead to bacteriemia but shock is usually absent

371
Q

Treatment for gram negative anaerobes
2 steps and 2 drug regimens based on location

A

Drainage and debridement
Antibiotics based on site
Oral/throat/neck - clindamycin or metronidazole
GI/Pelvic - Pip/Taz Carbapenems Metronidazole

Treatment anticipates a mixed infection

372
Q

3 organisms usually involved in bacterial vaginosis

A

Gardnerella
Prevotella, Peptostreptococcus, or bacteroides
Mycoplasma and Ureaplasma urealyticum (not anaerobes)

373
Q

Presentation of bacterial vaginosis (4)

A

Grayish vaginal discharge, fishy smell, elevated vaginal pH, Clue cells on microscopy

374
Q

“whiff” test

A

Vaginal secretions are mixed with KOH which alkalizes amines produced by anaerobic bacteria creating a sharp fish odor

375
Q

Clue cells

A

Vaginal cells wiht bacteria stuck to them as seen on microscopy

376
Q

3 antibiotics for bacterial vaginosis

A

Metronidizole (oral or vaginal), Clindamycin (oral or vaginal), Tinidazole (oral)

377
Q

Three atypical bacteria that cause pneumonia

A

Mycoplasma, Legionella, Chlamydia

378
Q

Pathogenesis and Epidemiology of Mycoplasma

A

Filamentous organism that likes to line epithelial membranes (esp. respiratory) and cause injury thereupon

Transmitted via respiratory droplets with a 2-3 week incubation period

379
Q

5 Signs/Symptoms of Mycoplasma

A

Mild or “walking” pneumonia, Non consolidated CXR, Bullous maryngitis, Cough, Scant sputum

380
Q

Diagnosis of mycoplasma

A

Diagnosed via NP swab, typically diagnosis is clinical, patchy infiltrates rather than consolidation on CXR

381
Q

Antibiotic of choice for mycoplasma CAP

A

Azithromycin

382
Q

3 types of chlamydia

A

Trichomatis - STD
Psittaci - Birds
Pneumoniae - What is sounds like

383
Q

Presentation and treatment of Chlamydia pneumoniae

A

Second MCC of walking pneumonia - also treat with Azithromycin

384
Q

Chlamydia Psittaci

A

Atypical pneumonia from fever, chills, cough, HA
Results from contact with birds
Treat with tetracycline or erythromycin

385
Q

Clinical manifestations of Chlamydia Trachomatis
3 for females, 3 for males, 2 for both

A

Female - Cervicitis, urethritis, PID
Male - Urethritis, epididymitis, prostatitis
Both sexes - Conjunctivitis, lymphogranuloma venereum

386
Q

Transmission of chlamydia trachomatis

A

Direct inoculation with infected genital secretions

387
Q

5 Female clinical presentations of Chlamydia

A

Mucopurulent discharge, Inflamed friable cervix, Pelvic pain, dyspareunia, and cervical motion tenderness

388
Q

3 Male clinical presentations of Chlamydia

A

Mucoid/watery urethral discharge, Dysuria, Epididymitis - testicular pain

389
Q

4 complications from chalmydia

A

Pregnancy complications, Infertility, Transmission to newborn, Perihepatitis (Fitz Hugh-Curtis syndrome)

390
Q

Perihepatitis

A

Inflammation of the liver capsule

391
Q

2 treatments for chalmydia

A

Doxycycline for 7 days or a 1 time Zmax shot

392
Q

3 spirochetes that cause disease

A

Treponema pallidum, Borrelia, Leptospira

393
Q

Agent, Transmission and incubation of syphillis

A

Treponema pallidum

Transmitted by direct contact with infectious lesion during sexual activity

21 day incubation period

394
Q

5 stages of syphillis

A

Primary, Secondary, Tertiary, Neuro, Latent

395
Q

Primary syphillis

A

Painless ulcer of Chancre most common on penis/labia but also possible cervically, anorectally, or oropharyngealy. Nontender regional lymphadenopathy

Occurs 3-4 weeks after contact; Heals spontaneously

396
Q

Diagnosis and Treatment of syphillis

A

Culture of ulcer - dark field microscopy, Serologic testing (first line), Antibody testing

Treat with benzathine PCN 2.4 million units IM 1 dose

Treat partner and REPORT!!

397
Q

Onset and manifestation of secondary syphillis (5 manifestations)

A

6 months after chancre

Generalized maculopapular rash, Condyloma lata (genital warts), Generalized LAN, Arthritis, Mucous membrane patches and ulcers

398
Q

Latent syphillis

A

Period w/o signs or symptoms

Still infectious within the first year after primary infection
Non-infectous after the first year since primary infection

399
Q

Tertiary Syphilis
Timing and 1 major symptom

A

Can occurs years after initial infection - delayed hypersensitivity response
Gummas or infiltrative tumors of the skin bones and internal organs (liver)

400
Q

Neurosyphilis

A

Complication that can occur at ANY stage of the disease but is most common in late syphilis

401
Q

Disease course of neurosyphilis - 4 stages

A

Asymptomatic invasion
Meningovascular syphilis - HA, poor reflexes, irritability
Tabes dorsalis - degeneration of the posterior columns of the spinal cord pains paresthesias, lack of bladder control, Impairment of vibration and proprioception
General paresis - personality change, memory loss, psychosis, tremors, slurred speach

402
Q

Lyme disease reservoir and vector

A

Reservoir in deer, transmitted by Ixodes tick

403
Q

1st stage of Lyme disease

A

Bull’s Eye lesion - Erythema migrans within 1 week of tick bite
Flu like symptoms that tend to resolve in 3-4 weeks

404
Q

Stage 2 of lyme disease (5)

A

Early disseminated infection including

Bacteremia
Secondary skin lesions and rash
Flu-like symptoms
Cardiac problems
Neurologic manifestations

405
Q

Stage 3 of Lyme disease

A

Late persistent infection months to years afterwards

Musculoskeletal issues
Neurological issues
Skin issues

Self limiting but recurrant

406
Q

Criteria for Lyme diagnosis

A

A person exposed to a tick bite who:

Developed erythema migrans or had at least one late manifestation

AND

Laboratory confirmation

407
Q

Lab testing for lyme disease (B. burgdorferi)

A

ELISA and confirm with Western Blot

408
Q

Treatment for Lyme disease

A

Doxycycline 10-21 days, don’t use for longer in children
Amoxicillin (in pregnancy) or Cefuroxime also are options

409
Q

Leptospirosis - Transmission, Presentation, Diagnosis and Tretment

A

Transmitted from food contaminated by rat urine
Can range from minor to fatal kidney/liver disease
Diagnose via serologic testing
Treat with doxycycline

410
Q

Rocky Mountain Spotted Fever

A

Caused by Rickettsia ricketsii, Deracentor tick with deer reservoir
73% fatality in the untreated

411
Q

5 states where RMSF is most common

A

NC, TN, OK, AR, MO

412
Q

Clinical presentation and diagnosis of RMSF
Timing
4 general symptoms
Rash progression
Diagnostic test

A

2-14 days after tick bite
Fever, chills, myalgias, HA, insomnia

Rash of faint macules progressing to papules then petechiae

Use serologic testing to diagnose

413
Q

Medication of choice for RMSF

A

Doxycycline

414
Q

3 other rickettsia diseases

A

Typhus, Ehrlichosis, Anaplasma

All produce rash, fever, and myalgia

415
Q

Diarrhea definition (acute, persistent, chronic)

A

More than 3 bowel movements per day OR liquidity of the feces

Acute less than or equal to 14 days
Persistent greater than 14 days
Chronic greater than 30 days

416
Q

3 causes of acute diarrhea

A

Infectous, Medication, Acute exacerbation of chronic disease

417
Q

7 clues to determine cause of diarrhea

A

Frequency and amount, Bloodiness, Fever, N/V, Cramps/tenderness/tenesmus, Volume depletion, Immunocompromised status

418
Q

Clinical presentation of inflammatory vs. non-inflammatory diarrhea

A

Inflammatory - Pathogen invade colon, causes blood or pus with diarrhea, fever, LLQ pain, fecal leukocytes
Non-Inflammatory - Invades small intestine, profuse watery diarrhea without blood, N/V, no fecal leukocytes

419
Q

7 Causes of inflammatory diarrhea (5 bacteria, 1 Virus, 1 Protist)

A

Bacterial: Campylobacter jejuni, Salmonella, Shigella, EHEC, C. Diff
Virus: Cytomegalovirus
Protist: Entamoeba histolytica

420
Q

9 Causes of Non-inflammatory diarrhea (4 bacteria, 2 viruses, 3 protists)

A

Bacteria: B. cereus, S. aureus, ETEC, V. cholerae
Viruses: Norovirus, Rotavirus
Protists: Giardia, Cryptosporidium, Cyclospora

421
Q

4 common causes of N/V accompanying diarrhea

A

S. aureus, B. cereus, Norovirus, Rotavirus

422
Q

1 common cause of diarrheal volume depletion

A

Vibrio cholerae

423
Q

diarrheal agents common in immunocompromised patients

A

CMV, Cryptosporidium, Isospora

424
Q

Some common food-foodborne pathogen connections you should know
Beef
Fried rice
Undercooked hamburger
Poultry/Eggs
Shellfish/Raw seafood
PO Antibiotics
Milk/Cheese

A

Beef - S. aureus
Fried rice - B. cereus
Undercooked hamburger - E. coli
Poultry/Eggs - Salmonella
Shellfish/Raw seafood - Vibrio spp
PO Antibiotics - C. diff
Milk/Cheese - Listeria

425
Q

2 preformed toxin producing diarrheal bacterial w/ onset

A

S. aureus and B. cereus - 4-6 hours

426
Q

2 Intestinal production toxin producing diarrheal bacteria w/ onset

A

E. coli and Vibrio - 24 hours

427
Q

3 mucosal invasion bacteria w/ onset

A

Campylobacter, Shigella, Salmonella

428
Q

Typical onset of viral diarrheal infections

A

24-48 hours

429
Q

Typical onset of protozoan diarrheal infections

430
Q

2 diarrhea related drugs contraindicated in children and pregnant women

A

Immodium and Pepto Bismol (also don’t use pepto bismol in inflammatory diarrhea)

431
Q

4 Lab tests for diarrheal diseases

A

Fecal leukocytes
Stool culture (often comes with Salmonella, Shigella, Yersinia, and Campylobacter - may need to specify)
Stool for O and P - Protozoa
Stool for C diff

432
Q

3 aspects of diarrhea management

A

Fluids and other supportive measures
Antidiarrheals (Loperamide (Immodium), Diphenoxylate, Bismuth (Pepto)
Antibiotics - Cipro or Levaquin most common empiric

433
Q

CSF Tap for Viral vs. bacterial meningitis

A

Viral is clear
Bacterial is cloudy

434
Q

Cutoff for AIDS

A

less than 200 CD4 cells per microliter or the presence of an AIDS defining condition

435
Q

6 bodily fluids that do NOT usually transmit HIV

A

Saliva, Sweat, Tears, Vomit, Urine, Nasal secretions

436
Q

MOA of HIV infection into cells

A

HIV enters a dendritic cell, traffics within the cell and then moves from it into a CD4 cell

437
Q

4 Stages of HIV infection

A

Viral transmission
Acute retroviral syndrome (flu like period of high viral proliferation, goes away and person thinks they are better)
Chronic HIV infection -Can be asymptomatic for a long time
Advanced HIV infection CD4 count under 50 cells/microliter

438
Q

4 parts of acute HIV infection

A

Viral penetration of mucosal epithelium
Infection spreads to Monocytes, dendritic cells, and CD4 cells
Infection spreads to lymph nodes
HIV viremia

439
Q

2 Types of macrophages that can harbor HIV making hard to combat

A

CD-14 and CD-16

440
Q

2 medical history aspects to consider for HIV

A

Transfusions, needle stick exposure

441
Q

3 social history components to consider for HIV

A

Sexual orientation, number of partners, drug use

442
Q

4 Physical exam components to consider for HIV

A

HEENT, lymph nodes, abdomen, skin

443
Q

5 Labs to consider for HIV - Think General

A

HIV testing, CBC, CMP, screening for STDs, Urinanalysis

444
Q

ART

A

Antiretroviral therapy

445
Q

Monitoring of the HIV+ patient

A

CD4 count and HIV Viral load should be monitored every 3-6 months

All patients should be offered ART regardless of CD4 count

446
Q

ELISA testing for HIV

A

can lead to false positive if too close to the inoculation event - confirm with second ELISA or a western blot

447
Q

Rapid HIV test

A

Quick results but need to be confirmed

448
Q

Serum p24 test

A

Tests serum for protein associated with HIV replication

449
Q

PCR test for HIV

A

CAN diagnose HIV during initial window - used for infant HIV testing

450
Q

Abicavar

A

HIV drug that can ONLY be used if one tests negative for human leukocyte antigen B15701

451
Q

Truvada

A

Pre-exposure prophylaxis for HIV (PrEP) combine with behavioral changes to prevent new infections

452
Q

Pregnancy and HIV

A

Always test for HIV in pregnant women
Initiate ART and consider C-section for HIV+ mothers
Advise NOT to breast feed after birth

453
Q

3 ways HIV can pass from mother to child

A

during pregnancy
during vaginal childbirth
through breastfeeding

454
Q

Effect of PrEP on HIV transmission for Gay men and Drug users

A

90% decrease for Gay men
75% decrease for drug users

455
Q

HIV and Tuberculosis

A

Test annually for TB
If positive CXR and start isoniazid 300 mg PO qd
If CXR with infiltrates send sputum for acid fast staining and start four drug therapy with a specialist
If negative PPD with high suspicion use interfereon gamma release assay

456
Q

What to look for on a CXR for TB

A

Upper lobe consolidations with or without mediastinal or hilar adenopathy

457
Q

4 things to avoid when having HIV

A

Raw meat eggs or shellfish (toxo, campylobacter, salmonella, Cat litter (Toxoplasmosis), cat scratches (bartonella), Tap water (cryptosporidium)

458
Q

First line ART for HIV in pregnancy

A

Zidovudine (retrovir)

459
Q

Post exposure healthcare worker prophylaxis (0636)

A

HIV antibody and viral load testing at baseline, 6 weeks, 3 months, 6 months

ART for 4 weeks

460
Q

Triple therapy for HIV prophylaxis

A

Tenofovir, Emtricitabine, dolutegravir OR raltegravir

461
Q

HAART (highly-effective antiretroviral therapy)

A

At least three medications from two different classes to avoid resistance

462
Q

6 classes of HIV drugs

A

Nucleoside reverse transcriptase inhibitors
Nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Entry/Fusion inhibitors
Integrase inhibitors

463
Q

What make a patient resistant to an antiretroviral drug

A

Genes, they can be resistant with NO prior exposure to the drug - testing is essential

464
Q

Nucleoside reverse transcriptase inhibitors

A

Can cause peripheral neuropathy
Often components of a fixed dose combination
Block conversion of VIral DNA to RNA

465
Q

Only nuceotide transcriptase inhibitor and some info about it

A

Tenofovir (viread)
Can lead to renal failure
Frequently in fixed dose combinations
Blocks conversion of viral DNA to RNA

466
Q

Non-Nucleoside reverse transcriptase inhibitors (NNRTIs

A

Inhibit reverse transcription and are well tolerated without special monitoring needed. Block conversion of Viral DNA to RNA

467
Q

Characteristics of Protease inhibitors for HIV (4)

A

Suppress HIV replication, administered as a combination therapy, CYP 450 inhibitors, used to boost other regimens

Block new HIV from maturation

468
Q

2 HIV entry fusion inhibitors

A

enfuviritide and maraviroc

469
Q

HIV entry/fusion inhibitors facts

A

Block HIV entry into cells by blocking receptors - add on therapy for patients who have multiple ART resistances

470
Q

Integrase strand transfer inhibitors (INSTIs)

A

Block HIV enzyme integrase needed for multiplication, allow for a more rapid decrease in viral load versus other regimens

471
Q

HIV integrase function

A

Inserts HIV DNA into CD4 cell DNA

472
Q

4 Pearls for monitoring ART therapy

A

Resistance testing
Adherence is KEY
Check for toxicity eveery 3-4 months
Check viral load 1-2 months after starting regimen every 3-6 months once stable

473
Q

Advance HIV infection definition

A

CD4 cell count under 50 cells per microliter

474
Q

Oral canddiasis

A

Opportunistic infection in HIV patients - pseumembranous plaques in mouth, common even in non-HIV patients

clotrimazole of fluconazole

475
Q

Musculocutaneous candidiasis

A

Inguinal rash - treat with clotrimazole or ketoconazole cream BID

476
Q

Oral hair leukoplakia

A

Caused by epstein-barr virus, white leison on lateral tounge that cannot be rubbed off with hairlike projections

Resolves with ART

477
Q

Genital herpes and HIV
General difference, appearance, treatment

A

More frequent, severe and likely to disseminate with HIV. Small grouped vescles treat for 5-10 days with acyclovir, famciclovir, valaciclovir

478
Q

Herpes Zoster shingles and HIV

A

Painful, vesicular dermatomal lesions 7-10 day treatment with famciclovir or valacyclovir. Consider vaccine for HIV+ individuals

479
Q

Molluscum Contagiosum

A

caused by pox virus - umbilicated fleshy papules treated with liquid nitrogen and imiquimod off label

480
Q

AIDS defining diseases (3)

A

Pneumocystis jiroveci (formerly carinii), Esophageal candidiasis, Karposi’s sarcoma

481
Q

Most common cause of pulmonary disease in HIV patients (3)

A

Community acquired pneumonia caused by:
Pneumococcal pneumonia
H. flu
Pseudomonas

482
Q

Pneumocystis jiroveci
How to detect on a CXR

A

Most common opportunistic infection seen with AIDS, Fungal and detected on CXR by diffuse or perihilar infiltrates

Fever cough dyspnea, hypoxemia

483
Q

Dx and Tx for P. jiroveci

A

Dx through sputum staining, usually elevated serum LDH

Treat with Bactrim and prednisone. Prophylax when AIDS begins

484
Q

Esophageal candidiasis

A

AIDS defining condition caused by C. albicans in most cases
Dysphagia or difficulty swallowing
EGD (scope) diagnosis
Fluconazole treatment

485
Q

Kaposi’s Sarcoma

A

AIDS defining condition caused by a herpes virus HHV8. Cancer of the lining of the blood and lymph vessels. Purplish painless non-blanching lesions appearing anywhere that resolve with ART. May be prone to flare ups

486
Q

Wasting syndrome

A

In HIV patients results from Anorexia, N/V aleading to decreased caloric intake
Includes malabsorption
Increased metabolic rate
Dispropotionate loss of muscle mass

487
Q

Treatment for HIV related wasting syndrome

A

ART, Megastrol acetate, steroids, medical cannabis

488
Q

Mycobacterium Avium and AIDS

A

Disseminated infection in late stage HIV
Persistent fever and weight loss
Use combination therapy and treat for 12 months
Clarithromycin recommended with ethambutol
Prophylax patients with CD4 count under 50

489
Q

Cryptococcal meningitis and AIDS

A

Budding yeast found in pigeon dung (we’re all exposed
Spread by inhalation and inhabits CNS
Serum test dx
Treat with IV liposomal amphotericin B with PO flucytosine for one year

490
Q

Cytomegalovirus retinitis

A

most common retinal infection seen with AIDS
Hemorrhages and exudates seen in a fundoscopic exam
Visual loss with optic nerve involvment and possible retinal attachment

491
Q

Treatment for Cytomegalovirus retinitis

A

Galacyclovir for 7-10 days and valgancyclovir for 21 days

492
Q

Toxoplasmosis

A

Causes CNS disese in AIDS patients
Dx with contrast-enhancing lesions on a brain CT scan
Serologic testing also an option
Treated with Pyrimethamine (antibiotic), sulfadiazine (antiparasitic), and leucovorin (folic acid

493
Q

Infection testing and prophylaxis for all HIV CD4 counts

A

TB annually with prophylaxis

494
Q

Infection testing and prophylaxis for HIV w/ CD4 count under 250

A

Coccidiomycosis annual with prophylactic fluconazole. DC when over 250 for 6 months

495
Q

Infection testing and prophylaxis for HIV w/ CD4 under 200

A

Pneumocystis with bactrim prophylaxis. stop when above 200

496
Q

Infection testing and prophylaxis for HIV w/ CD4 under 150

A

Histoplasmosis - limited data suggest itraconazole prophylaxis DC when CD4 over 150 for 6 months

497
Q

Infection testing and prophylaxis for HIV w/ CD4 under 100 (2)

A

Toxoplasmosis - bactrim prophylaxis if positive IgG serology DC when over 200 for 3 months
Cryptococcus - Prophylaxis not recommended

498
Q

Infection testing and prophylaxis for HIV w/ CD4 under 50

A

Mycobacterium avum - check blood cultures prior to treatment, prophylax with Zmax if cultures are negative. DC when CD4 over 100 for 3 months

499
Q

7 opportunistic pathogens to screen for in an HIV+ patient

A

TB
Coccidomycosis
Pneumocystis
Histoplasmosis
Toxoplasmosis
Cryptococcus
Mycobacterium avum

Infectious Disease and HEENT (4 decks)

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