Infectious Disease Exam 1 Cards Flashcards
1
Q
5 Types of Leukocytes measured in a differential CBC
A
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
2
Q
3 Granulocytes
A
Neutrophils, Basophils, Eosinophils
3
Q
2 Agranulocytes
A
Lymphocytes, Monocytes
4
Q
WBCs from most to least abundant (Hint: Never…..)
A
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils (Never Let Monkeys Eat Bananas)
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
6
Q
Lymphocytes
A
Common in viral infections and leukemias, B T and NK cells
7
Q
Monocytes
A
Largest WBCs, can migrate into tissue and are more common in CHRONIC infection
8
Q
Eosinophils
A
Found in skin, airways and blood. Found in allergic, parasitic, and chronic skin conditions
9
Q
Basophils
A
Defense in hypersensitivity reactions, release inflammatory mediators
10
Q
Fishbone CBC from top counter clockwise
A
Hgb, PLT, HCT, WBC
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
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
13
Q
Normal color of urine
A
Straw yellow color
14
Q
Interpretation of cloudy urine
A
Consistent with pyuria
15
Q
Normal odor of urine
A
Absent to mild odor
16
Q
Interpretation of strong fishy urine odor
A
Consistent with infection
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
18
Q
What do nitrites in the urine indicate
A
Gram negative bacteria are converting nitrates to nitrites, a UTI
19
Q
What would suggest and inadequate clean catch urine sample?
A
Too many epithelial cells
20
Q
Indication for KOH or Wet prep microscopy
A
Vaginal, Cervical, or Urethral discharge
21
Q
What do clue cells indicate?
A
Bacterial Vaginosis
22
Q
4 things best visualized with wet prep microscopy
A
Epithelial cells, Blood cells, Clue cells, Protozoans
23
Q
One thing better visualized with KOH prep microscopy
A
Fungal cells
24
Q
Clue cell
A
Stippled vaginal epithelial cell that indicates the presence of a probable infection
25
True vs. Pseudohyphae
True hyphae are filamentous pseudohyphae occur in unicellular fungi
26
Positioning for a lumbar puncture
Lateral decubitus if pressure measurement is needed, upright position if pressure is not needed
27
Desirable anatomic location for lumbar puncture
L3-L4 space or L4-L5 space
28
Where to locate the spinous process of L4
Line between the posterior superior iliac crests
29
What does pressure tell us in a lumbar puncture?
3-Increased pressure
2 - decreased pressure
Increased pressure can indicate infection, tumor, or intercranial bleeding
Decreased pressure can indicate dehydration or CSF leakage
30
4 CSF tubes to collect
Cell Count and differential
Glucose and protein levels
Gram stain, C&S
Other
31
Normal CSF fluid color
Clear and colorless
32
Indication of Cloudy or Xanthochromic CSF
Cloudy or Turbid = Infection
Xanthochromia = Bleeding
33
Indication of increased CSF viscosity
Indicates and infection or malignancy
34
What do RBCs in a spinal tap indicate
Bleeding or WHAT??
Bleeding or a traumatic tap
35
Normal CFS WBC count in adults and neonates
less than 5 in adults, less than 30 in neonates
36
Normal and abnormal CSF Glucose and protein
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)
37
3 additional CSF tests and what they mean
Lactic acid - elevated with bacterial or fungal infection
LDH - Elevated with bacterial infection and with leukemia
CRP - Elevated with inflammation, markedly with infection
38
Normal CSF pressure
80-200 mmH2O
39
Complications of a Lumbar puncture (6)
Headache, Traumatic tap, Dry tap, Infection, Hemorrhage, Cerebral herniation
40
Transudate
Clear fluid most commonly caused by CHF or cirrhosis
41
Exudate
Non-clear fluid caused by injury or inflammation
42
Lights criteria to determine exudate v. transudate
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
43
What does milky pleural fluid point to potentially
Lymphatic system involvement
44
What does reddish pleural fluid potentially point to?
Presence of blood
45
What might cloudy, thick, pleural exudate indicate
Presence of microorganisms or WBCs
46
What do decreased pleural fluid glucose levels indicate
Infection or malignancy if pH is also decreased
47
What do increased pleural fluid lactate levels indicate
Infectious pleuritis
48
What do increased amylase levels in pleural fluid indicate (3)
Pancreatitis, Esophageal rupture or malignancy
49
What do increased triglyceride levels in pleural fluid indicate
Lymphatic system involvement
50
When would we use pericardiocentesis
To diagnose the cause of pericarditis or pericardial effusion
51
Technique for pericardiocentesis
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
52
Purpose of performing paracentesis
Helps diagnose the cause of peritonitis or ascites
53
5 indications of milk colored peritoneal fluid
Malignant tumor, Lymphoma, TB, Parasitic infection, Hepatic cirrhosis
54
6 indications of cloudy or turbid peritoneal fluid
Peritonitis, Primary bacterial infection, Perforated bowel, appendicitis, pancreatitis, strangulated or infarcted bowel
55
3 causes of a blood peritoneal tap
Benign or malignant tumor, Hemorrhagic pancreatitis, perforated ulcer
56
Cocci that signal primary vs. secondary peritonitis
Gram + means primary
Gram - means secondary
57
RBC count cutoff for peritoneal malignancy
greater than 100 per microliter
58
RBC count cutoff for intra-abdominal trauma
greater than 100,000 per microliter
59
Abnormal white cell count for peritoneal fluid
greater than 300 per microliter
60
Interpretation of elevated triglyceride levels in peritoneal fluid
Malignant tumor, lymphoma, TB, Parasitic infection, cirrhosis
61
Abnormal protein level for peritoneal fluid and the interpretation thereof
Greater than 4 g/dL
TB and malignancy
62
Abnormal level for peritoneal fluid glucose and the interpretation thereof
Less than 6 mg/dL
TB and malignancy
63
Abnormal amylase threshhold for peritoneal fluid and the interpretation thereof
Greater than 50% serum level
Pancreatitis, pancreatic pseudocyst, pancreatic trauma, intestinal strangulation
64
Indication of increased alkaline phosphatase in the peritoneal fluid
Small bowel perforation and strangulation
65
4 symptoms that indicate for a potential arthrocentesis
Joint pain, joint swelling, Erythema, Warmth
66
Indication of yellow or green synovial fluid
Inflammatory or infectous
67
Indication of red, rusty or brown synovial fluid
Fresh or old blood
68
Indication of turbid/opaque synovial fluid
Abnormally large numbers of cells
69
Indication of string like synovial fluid
NORMAL
70
Indication of increased viscosity synovial fluid
Septic arthritis
71
Indication of decreased viscosity synovial fluid
Inflammation
72
4 diagnostic tests that can be performed on synovial fluid (Hint 3 for infection)
Crystal analysis, White cell count with differential, Gram stain, Bacterial culture and sensitivity
73
4 indications for a chest X-ray
Dyspnea, Cough, Fever, Pleuritic chest pain
74
5 things to look for on a chest X-ray
Consolidation, infiltrates, cavitations, nodules, effusions
75
What do patchy lungs on an X-ray indicate
Pulmonary edema
76
What and X-ray does and does not tell you
Can give clues to the causative organism but is not definitive. Luckily you may not need to know the exact organism to treat
77
CT vs. MRI scanning
CT
Fast, Sees bone, Allows for contrast
MRI
Take longer, No metal, Contrast, Shows tissues
78
Difference between Gram negative and Gram Positive Bacteria
Peptidoglycan and Stain color
Gram positive HAVE peptidoglycan and stain PURPLE
Gram negative LACK peptidoglycan and Pinkish red with the counterstain
79
Steps for a gram stain
1.Add crystal violet
2.Add iodine
3. Rinse with ethyl alcohol
4.Counterstain with Safranin Red
80
Gram stain of atypicals
Typically do not stain
81
Gram Positive Cocci (3)
Streptococcus (chains) Staphylococcus (clusters) Enterococcus
82
Gram positive rods (5)
Corynebacterium, Clostridium, Bacillus, Lactobacillus, Listeria
83
Gram Negative Cocci (3)
Acinetobacter, Moraxella, Neisseria
84
If you are starting on antibiotics when is the BEST time to take a culture
BEFORE giving any antibiotics
85
Blood culture method and interpretation
Must take two samples from two locations. If only one is positive contamination may have occured
86
3 indications for a wound culture
Drainage of fluid or puss, Heat redness swelling or tenderness at the sight, Wound is slow to heal
87
3 Indications for a stool sample
Diarrhea lasting more than a few days, Ingestion of suspected contaminated foods, Recent travel outside of the US
88
What should you order if you suspect GI parasites?
A stool for ova and parasites test, not just a stool sample
89
Most common UTI pathogen
E. Coli
90
Diagnostic criteria for a UTI
Greater than 100,000 colonies of a single bacteria
91
When would you order a sputum culture
When you suspect and infection in their lungs
92
3 Methods of sputum collection
Patient produced
Aerosol induced
Nasogastric
93
Causative agents of the following sputum findings:
Rust colored
Yellow/Green
Green
Currant Jelly
Bloody
Foul Smelling
Thin/Scant
Rust colored - Strep. pneumo
Yellow/Green - H. flu
Green - Pseudomonas
Currant Jelly - Klebsiella
Bloody - Tuberculosis
Foul Smelling - Anaerobes
Thin/Scant - Atypicals
94
Requirements for Sputum TB testing
Acid Fast testing: requires 3 separate sputum samples of 12 weeks for a definitive diagnosis
95
Sputum testing for fungal and atypicals
Fungal - Often need a biopsy or serum test
Atypical - Don't grow on ordinary sputum culture media
96
How to proceed after a rapid strep test
If positive, no further testing needed
If negative, obtain a culture
97
Five conditions for which strep testing is NOT recommended
In children under 3 years old
Routine screening of asymptomac exposures
Cough
Runny nose
Mouth Sores
98
Centor Criteria for strep (6)
History of Fever
Tonsilar exudate
Tender anterior cervical adenopathy
Absence of cough
Modified
Under 15
Over 44 (-1)
99
Centor criteria scores interpretation
0-1 No culture, No abx
2-3 Obtain culture, if positive use abx
4-5 Treat empirically with Abx
100
3 Pathogens you can detect with a nasal swab
Respiratory virus panel
Influenza
Covid
101
When IS sensitivity testing indicated (4)
Unknown or mixed pathogens
Known resistance
Severe infection
Infection not responding
102
Order for sensitivity testing
Should read "Culture and Sensitivity Testing" or C&S
103
Minimum Inhibitory Concentration
Smallest amount of a drug that inhibits the bacteria
104
When should antibiotic treatment be initiated in relation to a sensitivity test
Start it prior to recieving C&S results
105
Interpretation of susceptibility testing
S=Succeptible
I=Intermediate
R=Resistant
Lower numbers are better
106
What exactly does penicillin bind to?
Transpeptidase enzymes which crosslink peptidoglycan chains in gram positive bacteria
107
4 Classes of Beta Lactams
Penicillins, Cephalosporins, Carbapenems, Monobactams
108
4 Types of antibiotics that act of the cell wall
Beta lactams, Vancomycin, Bacitracin, Polymixins
109
Bactericidal and Bacteriostatic functions of penicillin
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
110
3 ways bacteria can become resistant to penicillin
Reduce affinity for PBPs
Produce beta lactamases
Overproduce PBPs
111
Which tastes better? Penicillin or Amoxicillin
Amoxicillin
112
3 anti staphylococcal PCNs
Dicloxacillin, Nafcillin, Oxacillin
113
Indication for anti staphylococcal PCNs
Only for skin and soft tissue infections, not effective against MRSA
114
What is methicillin used for
Identifying microbial resistance
115
2 Aminopenicillins
Amoxicillin, Ampicillin
116
2 First line indications for Aminopenicillins
Otitis Media, Endocarditis prophylaxis
117
3 MCC of otitis media
H. flu, M cat, Strep pneumo
118
2 advantages of aminopenicillins over regular PCNs
Higher oral absorption and Longer half life
Superior gram negative coverage
119
2 PCN beta lactamase inhibitor combinations
Amoxicillin/Clavulanic Acid (Augmentin)
Ampicillin/Sulbactam (Unasyn)
120
First line indications for Augmentin
Sinusitis and Pneumonia/COPD exacerbations by
S. pneumo
H. flu
S. Aureus
121
3 considerations for Amoxicillin/Clavulanic Acid (Augmentin)
Increased cost
More GI side effects
Often reserved for more severe/refractory infections
122
Extended spectrum penicillins description
amino PCN with a Urea group added, also cover pseudomonas - PIP and TAZ!
Succeptible to beta lactamase
123
Indications for PIP and TAZ
Severe polymicrobial infections
124
Only available route for Piperacillin/Tazobactam
IV
125
Rule of thumb for cephalosporin generations
The greater the generation the better the Gram - coverag
The lower the generation the better the Gram + coverage
126
Three 1st generation cephalosporines
Cephalexin (Keflex), Cefazolin (Ancef), Cefadroxil (Duricef, Ultracef)
127
Indications for Cephalexin (Keflex)
CAN USE FOR PREGNANCY!!
4x per day - be aware
Minor skin infections, Impetigo, Pharyngitis/OM, E coli cystitis
128
2 Indications for Cefazolin (Ancef)
Clean Surgical Prophylaxis, Serious MSSA infections
129
Five 2nd generation cephalosporins
Cefuroxime (Ceftin)
Cefoxitin (Mefoxin)
Cefotetan (Cefotan)
Cefaclor (Ceclor)
Cefprozil (Cefzil)
130
Indications for 2nd Gen cephalosporins
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
131
Clean v Dirty surgery
Clean = Non GI/GU
Dirty = GI/GU
132
Eight third generation cephalosporins
Know the first TWO and ending of most
Ceftriaxone (Rocephin), Cefdinir (Omnicef), Cefditoren (Spectracef), Cefixime (Suprax), Cefotaxime (Claforam), Cefpodoxime (Vantin), Ceftazidime (Fortaz), Ceftibuten (Cedax)
133
First line indication for Ceftriaxone (Rocephin)
Neisseria gonorrhoeae
Also has good pneumococcal coverage
Surgical prophylaxis
Meningitis
PID
IV or IM
134
Indications for Cefdinir (Omnicef) and Cefixime (Suprax)
Second line for upper and lower respiratory tract infections
Also skin and soft tissue but PO only
135
4th generation cephalosporin
Cefepime:
Gram +, -, pseudomonas
Indicated for severe infections and meningitis because of high CSF penetration, IV or IM
136
5th generation cephalosporin
Ceftaroline (Teflaro)
Covers Gram + and VRE
IV only
137
Monobactam antibiotic
Aztreonam (Azactam)
138
Coverage of Monobactams
Good gram - including pseudomonas but no coverage of Gram + or anaerobes
139
Indications for Monobactams (3)
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
140
4 Carbapenems
Imipenem/Cilastatin
Meropenem
Ertapenem
Doripenem
141
Why is Cilastatin added to Imipenem?
To prevent inactivation in the renal tubule of the kidney
142
Coverage for Carbapenems
Broad Spectrum!!
Gram-, Gram+, Anaerobes, Pseudomonas (except for Erta)
NO MRSA COVERAGE
143
5 Indications for Carbapenems
Severe infections of:
Urinary Tract
Meningitis
Peritonitis
Resistant wounds
Osteomyelitis
144
2 common side effects of beta lactams
GI - N/V/D
Vaginal candidiasis
145
5 potential adverse events from beta lactams
Hypersensitivity, C. diff, Nephritis, Anemia, CNS toxicity
146
5 signs of a TRUE anaphylactic reaction
Immediate or within an hour
Hives
Angioedema
Wheezing or SOB
Anaphylaxis
147
Pharmakokinetics of Beta lactams
Minimal liver interaction or CYP450 metabolism
Renal excretion
148
Monitoring and safety for beta lactams (3)
Monitor CBC and Kidney function
Pregnancy category B
Decrease effectiveness of oral contraceptives
149
2 Glycopeptides
Vancomycin and Telvancin
150
MOA of glycopeptides (Vancomycin)
Bactericidally inhibit cell wall synthesis by binding to D-ala D-ala side chains of peptidoglycan
151
Coverage of Vancomycin
Gram positive bacteria including MRSA but no gram negative coverage
152
First line indications for Vancomycin
Inpatient MRSA therapy - IV
Severe or refractory C. diff - PO
153
Pregnancy category for Vancomycin
Oral - B
IV - C
154
Pharmacokinetics of vancomycin
No liver metabolism, renal excretion
155
Loading dose for Vancomycin
Indicated in severe infections 25-30 mg/kg
156
Monitoring protocol for vancomycin therapy
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
157
Drug of choice for VRE
Daptomycin
158
3 Adverse effects of Vancomycin
Red Man Syndrome, Nephrotoxicity, Ototoxicity
159
3 alternatives for vancomycin
Telavancin - almost the same
Daptomycin - VRE but NOT pneumonia
Linezolid - Also VRE
160
4 aminoglycosides
Gentamicin, Tobramycin, Amikacin, Streptomycin
161
MOA of aminoglycosides
Bind to the 30s subunit and inhibit protein synthesis - bactericidal
162
4 modes of resistance to aminoglycosides
Ribosomal mutation, Enzymatic destruction, Lack of permeability, Efflux pumps
163
Indications for Aminoglycosides (2)
Gram negative and M. tuberculosis
164
3 Black box warnings for aminoglycosides
Ototoxicity, Nephrotoxicity, Neuromuscular paralysis
165
Most frequent combination with aminoglycosides
Penicillin (for G+ coverage) Ampicillin/Gentamicin
166
Pregnancy category for aminoglycosides
D
167
3 Tetracyclines
Tetracycline, Doxycycline, Minocycline
168
MOA of tetracyclines
BacterioSTATIC bind to the 30s subunit and block RNA
169
2 resistance mechanisms for tetracyclines
Active efflux of the drug, Enzymatic deactivation
170
Spectrum of tetracyclines
MRSA, G+, G-, ATYPICALS
171
First line and additional treatment indications for tetracyclines (4&2)
First Line: Lyme, Rocky Mountain Spotted Fever, Cholera, Acne
Additional: Chlamydia, Empiric CAP
172
Tetracycline contraindications
Pregnancy
Absolute in 8-9 y/o children (teeth staining)
Relative in 13 y/o children
173
Tetracycline contraindications
Pregnancy (long bone growth and teeth coloration)
Absolute in 8-9 y/o children (teeth staining)
Relative in 13 y/o children
174
PK of Tetracyclines
Hepatic metabolism excreted renally and hepatically
175
2 things that interfere with tetracycline absorption
Antacids and TUMS
176
5 adverse effects of tetracyclines
GI, Hepatotoxicity, Photosensitivity, Vertigo (minocycline), Candida or C diff infections
177
3 macrolides
Azithromycin (Zithromax), Erythromycin, Clarithromycin (Biaxin)
178
MOA of macrolides
Bacteriostatic - inhibits protein synthesis and ability to replicate by binding to 50s subunit
179
3 methods of macrolide resistance
50s subunit modification
Efflux pumps
Degradation enzymes
180
Macrolide spectrum (6 bacteria)
DO NOT CROSS BBB
Atypicals, Mcat, H flu, Legionella, S&S, Diptheria
181
First line indications for macrolides (5)
Second line (2)
Community Acquired Pneaumonia, Chlamydia, Legionella, Diptheria, COPD
Second line:
OM, pharyngitis
182
PK for macrolides
CYP 450 inhibitor
Primarily bile eliminated
183
4 adverse effects of macrolides
GI - N/D
Hepatotoxicity
Pronged QT
Ototoxicity
184
MOA of clindamycin
50s subunit inhibition
185
Clindamycin spectrum
Gram+ with some MRSA and Anaerobes
186
4 clindamycin indications (Conditions not bacteria)
Oral abscess, endocarditis prophylaxis, Bacterial vaginosis, Skin/soft tissue infections
187
Clindamysin 3 side effects
Diarrhea, Rash, Nausea
188
Clindamycin pregnancy category
Category B
189
Clindmycin Black Box Warning
Pseudomembranous colitis (C. Diff)
190
3 Quinolones
Ciprofloxacin, Levofloxacin, Moxifloxacin
191
MOA of Quinolones
Bactericidal - Inhibit DNA gyrase and Topoisomerase IV
192
3 mechanisms of resistance to quinolones
Decreased permeability, Efflux pump, Enzyme mutation
193
Spectrum of Quinolones
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
194
First line treatment indications for quinolones
Otitis EXTERNA - cipro/levo
Pyelonephritis
Prostatitis
Infectious diarrhea
Anthrax
Cipro for belly button down, Levo and Moxi for belly button up
195
Quinolones Black Box Warning
Tendinitis, Tendon Rupture
196
5 side effects of quinolones
Lowers seizure threshold, Nephrotoxic, Glucose alterations, Photosensitivity, C. diff
197
Bactrim is....
Trimethoprim/Sulfamethoxazole
198
Mechanism of Bactrim
Trimethoprim is a folate reductase inhibitor
Sulfamethoxazole is a folate synthesis inhibitor
199
5 coverages of Bactrim
Pneumocystis Jiroveci
Listeriosis
Prostate and UTI
GI infections
Respiratory infections
Mostly Gram negative coverage
200
First line indications for Bactrim (3)
Outpatient MRSA (use Clindamycin if allergic)
UTI/Cystitis
P. Jiroveci prophylaxis
Can also be good for legionella though not first line
201
4 adverse reactions of bactrim
Megaloblastic anemia
GI N/V/D
Photosensitivity
Hepatotoxicity
Pregnancy C
202
Combo that makes up nitrofurantoin
Macrobid/macrodantin
203
MOA and use of Nitrofurantoin
Inhibit bacterial enzymes and damages DNA - Only active in the urine and thus useful for UTIs
204
2 Cautions for Nitrofurantoin
Avoid in pregnancy
Do not use in severe renal impairment
205
MOA of metronidazole (Flagyl)
Disrupts microbial DNA
206
Spectrum of Metronidazole (4 anaerobes, 3 protozoans)
Anaerobes - Clostridium, Bacteroides, Fusobacterium, Gardenerella
Protozoans - Trichomonas, Giardia, E. Histolytica
207
5 first line treatments for metronidazole
Trichamonas, Bacterial Vaginosis, C. diff, Amebiasis, Giardiasis
208
5 Cautions/Adverse effects for Metronidazole (Flagyl)
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
Silver sulfadiazine (silvadine)
Folate synthesis inhibitor with the same ingredient as bactrim. Topical cream for burns QD or BID
210
Sulfacetamide
Folate synthesis inhibitor with sulfa ingredient of bactrim and ingredient similar to trimethoprim. Solution or ointment for opthalmic infections
211
Pyrimethamine (Daraprim)
Antiparasite/Antimalarial Folate reductase inhibitor, used to treat malaria and toxoplasmosis
212
Bacitracin - What it is, What it targets, How it is used
Polypeptide active against gram negative bacteria, limited to topical use dues to nephrotoxicity - Like trimethoprim
213
Polymixin B
Polypeptide with Gram negative coverage. Usually used for opthalmic drops especially pseudomonas
Parenteral forms reserved for highly resistant gram negative organisms
214
Chloramphenicol
Misc. synthetic antibiotic with broad spectrum and many side effects - last resort. Hematologic toxicity even when topical. IV or opthalmic solution
215
Mupirocin (Bactroban)
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
4 species of Staph and what they are known for
S. aureus - most pathogenic
S. epidermis - Skin and hospital acquired
S. saprophyticus - UTI
S. lugdunensis - Foreign body, prosthetic infections
217
Coagulase positive staph species
S. aureus only
218
Mode of transmission and related diseases of Staphylococcus
Direct tissue invasion MC
Also exotoxin production
Skin and soft tissue, Septic arthritis, Pneumonia, Endo carditis
Food poisoning and toxic shock syndrome
219
Treatment for MRSA skin infections
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
Treatment for inpatient Staphylococcus infection
First line - Vancomycin IV
Clindamycin, Cefazolin, Nafcillin/Oxacillin also options
221
Detection and treatment of Staphylococcal osteomyelitis
Confirm with X-ray
Start with Vanc. and 3rd or 4th generation cephalosporin then taper to culture and susceptibility
222
3 potential causes of TSS
Tampon use, Nasopharyngeal packing, Direct wound innoculation
223
Presentation of TSS 7 symptoms
Sudden onset fever, myalgia, and N/V, Erythrematous rash that desquamates, thrombocytopenia, renal impairment syncope and shock may follow
224
Treatment of toxic shock syndrome
Admit, Support (IV fluids, etc.), Debride/decontaminate, Empiric antibiotics (vanc and clinda, and choose 1 pip/taz or cefepime or carbapenem)
225
Presentation of scalded skin syndrome
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
Diagnosis and treatment of Scalded Skin syndrome
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
Treatment and pathology of coagulase negative staph infections
Usually hospital acquired from operations, prosthetics, or catheters. Usually resistant and treated with vancomycin
228
3 types of beta hemolytic strep and what they are known for
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
8 common infections of Strep Pyogenes
3 Pharyngeal
3 Skin
2 Systemic
Strep throat, Peritonsilar abscess, Scarlet fever
Impetigo, Erysipelas, Cellulitis
Rheumatic fever, Delayed acute glomerulonephritis (can take up to 2 weeks to appear)
230
6 signs of strep pharyngitis
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
3 lines of strep pyogenes treatment
PO or IM penicillin (VK or G respectively)
Amoxicillin 2nd line
Cephalosporin if allergic
Azithromycin as a last resort
232
Rash of scarlet fever presentation
Diffuse rash with papules that may become petechiae, strawberry tongue, flushed face
233
Presentation of impetigo
Focal, vesicular, pustular lesions with a thick honey colored crust and stuck on appearance - can also be S. Aureus
234
6 antibiotics for impetigo 3 for non-MRSA 3 for MRSA
Topical muciprocin, cephalexin, dicloxacillin
MRSA - Bactrim, doxycycline, clindamycin
235
Presentation of erysipelas
Painful superficial cellulitis with dermal lymphatic involvement that involves the face can also be caused by S. aureus
236
Inpatient and Outpatient Erysipelas
Outpatient/ non systemic - Pen VK or amoxicillin first, dicloxacillin cepalexin, clinda erythro secon
Inpatient/ systemic - Vancomycin, Cefazolin, Ceftriaxone, Clinda
237
2 common causes of cellulitis
Group A beta hemolytic strep or S. aureus
238
Strep Agalactiae (Group B) and pregnancy
When to test and 4 treatment options
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
2 alpha hemolytic strep
S. pneumoniae - Upper and Lower respiratory tract infections
S. viridans - Normal mouth flora, native valve endocarditis
240
2 differential diagnoses to consider in necrotizing fasciitis
GABHS or C. perfringens
241
5 diseases caused by Strep pneumo
MCC of community acquired pneumonia
Otitis media
Sinusitis
Meningitis
Endocarditis
242
6 symptoms of otitis media
Otalgia, hearing loss, fever, nausea, vomiting, irritability
243
3 risk factors for pediatric otitis media
Smoking in the household, family history, bottle feeding
244
3 signs of otitis media
Erythromatous/bulging TM, Lack of light reflex and motility, Otorrhea with TM rupture
Can also do a tympanogram but not always necessary
245
First, Second and THird line treatments for OM
Start with amoxicillin, then use Augmentin/Omnicef(straight to this if TRUE PCN allergy)
THEN Rocefin and refer to an ENT
246
Progression of acute sinusitis
Usually starts as viral and then develops a secondary bacterial infection
247
Diagnostics for acute sinusitis
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
Most common cause of community acquired pneumonia
Strep Pneumo
249
6 Signs and Symptoms of Strep Pneumo CAP
High fever w/ chills
Early onset rigors (shaking chill)
Productive cough with rust colored sputum
SOB
Pleuritic chest pain
Crackles in affected lobe
250
Diagnosis for Strep Pneumo CAP
Lobar consolidation with some effusion
Only obtain a sputum culture if comorbidities are present
251
Outpatient Treatment for S. pneumo CAP 3 with comorbidities 3 without
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
Inpatient treatment for S. pneumo CAP
Levofloxacin OR macrolide (ie. Zmax) and beta lactam (amoxicillin or ceftrioxone)
253
Two diagnostic tools to determine whether or not to admit CAP diagnosed patient and what tests you need for each
CURB-65 Need BMP
PSI - Need ABG
2+ Consider admittance
3+ Definitely admit
254
MCC causitive organism for Meningitis based on ages
Under 3 months
3 months to 10 years
10-19 years
Adult
Elderly
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
2 types of enterococcus where they are found and 5 things they can cause
E. faecalis and E. faecium
Normal intestinal flora
Cause: UTI, Bacteremia, Endocarditis, Intra-abdominal infections, Wound infections
256
Treatment for Enterococcus infections
Endocarditis
Skin/Wound/UTI
VRE
Endocarditis - Ampicillin and Gentamicin
Skin/wound/UTI - Ampicillin or vancomycin
For VRE - Linezolid or daptomycin
257
3 Gram positive rods
Bacillus, Listeria, Corynebacterium
258
2 species of bacillus
B. anthracis and B. cereus
259
Incubation and 3 signs of Cutaneous anthrax
Occurs within 2 weeks of toxin exposure
PAINLESS black eschar
Regional adenopathy
Fever, malaise, headache
260
Cause and 5 symptoms of GI anthrax
Inadequately cooked meat of infected animals
Fever, N/V/D w/ blood
GI bleed
Ulcerations of GI tract
Bowel obstruction and perforation
261
Cause and 5 symptoms of Inhaled Anthrax
Inhalation of anthrax spores
Insidious onset of flu like symptoms
Chest pain and respiratory distress
Hypoxemia and shock
Pleural effusion
Septicemia and meningitis
262
Diagnosis (4) and Treatment for Anthrax infection
Culture/Biopsy, Gram Stain, Nasal Swab, CXR
IV cipro 7-10 days cutaneous 60 days for inhaled
Doxycycline as alternate tx
263
2 types of illness caused by B. cereus toxins
Diarrheal or Emetic, occurs within 1-10 hours of exposure. Usually from leftover (ie. rice) Fluids and rest are recommended tx
264
2 pregnancy risks from listeria monocytogenes
Spontaneous abortion and Neonatal meningitis
265
4 general aspects of literiosis presentation
Bacteremia, Meningitis, Dermatitis, Oculoglandular symptoms
266
Dx and Tx for Listeria
Culture of Blood and CSF
Ampicillin and Gentamicin OR amoxicillin OUTPATIENT
267
Presentation of pharyngeal and nasal Diphtheria
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
3 treatment steps for Corynebacterium diptheriae
Diphtheria equine antitoxin
PCN or erythromycin
Treat contacts with erythromycin
269
3 Gram negative cocci
Acinetobacter, Moraxella, Neisseria
270
3 things to know about acinetobacter
Opportunistic pathogen
Can affect any organ system (respiratory most common)
Can survive on dry surfaces for up to a month
271
3 conditions caused by Moraxella catarrhalis
OM, Sinusitis, COPD exacerbations
272
2 species of Neisseria
N. meningitidis and N. gonorrheae
273
Characteristics of N. meningitidis
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
6 signs/symptoms of N. meningitidis meningitis
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
Diagnosis and Tx for Neisseria meningitis
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
CDC recommendation for Meningococcal vaccine
vaccinate at 11-12 and boost at 16
277
7 disease states of Neisseria Gonorrheae
Cervicitis/Urethritis
PID (Pelvic inflammatory disease)
Prostatitis
Disseminated disease
Skin rashes
Septic Arthritis
Newborn conjunctivitis
278
3 cervical presentations of gonorrhea
Yellow/green dicharge, Erythromatous, Firable (bleeds easily)
279
Dx and Tx for gonorrhea
Gram stain and culture (G- intracellular diplococci)
1 dose of cephtriaxone (rosephin)
Must report to health department
280
Origin and Common Infections of Pseudomonas
Found in water and soil
Causes opportunistic infections
OT, UTI, Dermatitis in healthy individuals
Pneumonia, Bacteremia, Sepsis in immune compromised, CF, and Burns
281
4 diseases for which pseudomonas is the no. 1 pathogen
Otitis Externa
Corneal ulcers in contact lens wearers
ICU-related pneumonia
Osteochondritis after tennis shoe puncture
282
Disease for which pseudomonas is the number 2 pathogen
Nosocomial Pneumonia
283
Disease for which pseudomonas is the no. 3 pathogen
Hospital acquired UTIs
284
Unique disease associated with Pseudomonas and its 3 symptoms
Folliculitis:
Plaques, papules, and pustules
Pruritus
7-10 day duration
285
Clinical presentation of pseudomonas
Most common symptom is fever, depends on site infected UTI, OE, and Respiratory infections most common
286
Inpatient and Outpatient treatment for pseudomonas
Outpatient:
Cipro/Levofloxacin (Levaquin)
Inpatient (IV):
Pip/Taz(Zosyn), Ceftazidime (Fortaz), Cefepime(Maxipime), Meropenem, Aztreonam
For Cystic Fibrosis Patients
Tobramycin inhaled
287
4 Gram negative rod respiratory tract illness bacteria
B. pertussis
H. flu
Legionella
Klebsiella
288
3 stage presentation of Pertussis
Catarrhal - insidious onset with some sneezing/cough
Paroxysmal - worsening cough with "whoops"
Convalescence - Symptoms diminish, cough may persist for some time
289
Diagnosis, Treatment and Prevention of pertussis
Diagnosed via nasopharyngeal culture
Treated with azithromycin (bactrim can be backup)
Prevented by vaccine (Tdap)
290
8 diseases that can be caused by H flu (Becomes Pneumonia)
Sinusitis
OM
Bronchitis
Epiglottitis
Pneumonia
Cellulitis
Meningitis
Endocarditis
291
What three things is H flu a common cause of and what 1 rare thing is it the number one cause of?
Sinusitis, OM, Respiratory
Epiglottitis
292
Source and common patient population of Legionella
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
Presentation of Legionairre's disease including CXR
4 Things
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
Treatment and time for legionella
Macrolide or floroquinolone 10-14 days or 21 days if immune compromised
295
Typical patient population for Klebsiella infections
Immune compromised persons - Alcoholics, Diabetics, HIV
Can cause UTIs and is normal intestinal flora
296
Clinical presentation of Klebsiella 3
Severe SOB and pleuritic chest pain
Red currant jelly sputum
Can progress to a lung abscess
297
2 diagnostic tools for klebiella
CXR and sputum culture
298
Treatment for Klebsiella
Very resistant so susceptibility testing is a must
Empiric treatment with a respiratory fluoroquinolone or Carbapenem
299
5 GI illness gram negative rods
Escherichia coli, Campylobacter, Salmonella, Shigella, Vibrio
300
7 symptoms of an E. coli infection
4-5 loose watery stools per day
Urgency to defecate
Abdominal cramps
N/V
Fever
Bloating
Dehydration
301
3 treatments for E. coli travelers diarrhea
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
Tenesmus
Urgency to defecate but nothing comes out
303
Presentation and treatment for Campylobacter Jejuni
One of the most common causes of foodborne illness
Bloody diarrhea, dysentery, cramps, fever, and pain
Treat with ciprofloxacin or Zmax
304
Shigella presentation and treatment
4 symptoms, 2 drugs
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
Presentation of Cholera
Sudden vluminous stool - gray color without blood or mucus or fecal odor "rice water stool" Diagnose via stool culture
306
Treatment for cholera
Hydrate
Tetracycline/Doxycycline
Bactrim
Zmax
Cipro
307
3 non-cholera vibrio infections
Parahaemolyticus
Mimicus
Hollisae
308
Presentation and treatment of non-cholera vibrio illnesses
Watery diarrhea, tenesmus and abdominal cramping
Cellulitis
Dx with stool culture
Treat with doxy or cipro
309
2 Types of salmonella infection
Enteric fever and Acute enterocolitis
309
2 Types of salmonella infection
Enteric fever and Acute enterocolitis
310
5 symptoms of typhoid fever
Pea soup diarrhea, Rose spots, Fever, positive salmonella culture, exhaustion
311
Treatment for typhoid fever (salmonella typhii)
Ciprofloxacin/Levofloxacin
Ceftriaxone
Azithromycin
312
Presentation for salmonella enterocolitis and treatment
3 Symptoms, 4 Treatments
Nausea, cramping, ABDOMINAL PAIN , AND DIARRHEA
Do not treat in uncomplicated cases
Cipro, Rocephin, Zmax, or bactrim for serious cases
313
UTI
An infections anywhere in the urinary system (urethra, bladder, kidneys, etc.)
314
Pyelonephritis
An untreated UTI that has spread to the kidneys and can cause permanent damage
315
MCC and three other species often responsible for a UTI
E. coli - MCC
Also consider Klebsiella, Proteus mirabilis, Enterobacter
316
5 treatments for UTI/Uncomplicated cystitis
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
3 Treatments for pyelonephritis
Cipro
Levofloxacin (Levquin)
Ceftriaxone plus [Bactrim, Augmentin, or Omnicef)
318
Black death "bubo"
Name for a massively swollen lymph node characteristic of a Yersinia Pestis infection
319
3 modes of bubonic plague
Bubonic
Septicemic
Pneumonic
320
Presentation of bubonic plague
Large swollen suppurative lymph nodes
Tachnypnea with productive cough and bloody sputum
Toxicity and comatose state - black plaques on extremities
321
Treatment and prophylaxis for Bubonic plague
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
3 vectors of tularemia
Rodents, Rabbits, Ticks
323
Presentation of tularemia
Most virulent contagious bacteria known (one of)
Fever, HA, prostration, Lymphadenopathy, Papule to ulcer at site of innoculation
324
4 drugs to treat tularemia
Streptomycin. Gentamicin, Doxycycline, Fluoroquinolones
325
Threshold for a fever
100.4 degrees F or 38 degrees C
326
Definition of Fever of Unknown Origin
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
4 Flavors of FUO
Classic FUO
Hospital Acquired FUO
Immunocompromised/neutropenic FUO
HIV-related FUO
328
Best site to take temperatures for fever
Oral is possible
Rectal or axillary for infants (need to add 1 to axillary temp generally)
329
4 differential diagnoses for FUO
Noninfectious (Vasculitis, Lupus, Granulomatous disorders)
Infectious (TB, Cat scratch, EBV)
Malignant/Neoplastic
Misc (Cirrhosis, Crohn's, PE)
330
Treatment for FUO
Don not treat empirically, collect as much info as possible and treat etiology if determinable. Refer if etiology cannot be determined
331
Criteria for Systemic inflammatory response
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
4 factors that can contribute to SIRS
Ischemia
Inflammation
Trauma
Infection
333
Difference between Bacteremia and Septicemia
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
Most common cause of septicemia
Respiratory infection, Gram + bacteria are usually most prevelent
335
qSOFA criteria for sepsis
Respirations over 22/min
Altered mentation
Systolic BP under 100 mmHg
Do SOFA score if criteria are met (at least 2)
336
Other notable signs of Sepsis (6)
High glucose w/o diabetes
CRP 2 SD above normal
Oliguria - acute
Hyperlactatemia
Thrombocytopenia
Diminished capillary refill with mottling
337
Criteria for sepsis
2 SIRS criteria and a confirmed or suspected infection
338
Criteria for severe sepsis
Sepsis + Signs of end organ damage, SBP under 90 Lactate over 4 mmol
339
Septic shock signs
Severe sepsis with persistent signs of end organ damage, SBP under 90, Lactate over 4mmol
340
Treatment for Sepsis (5)
Start abx therapy within 1 hr
Use multiple empiric abx's
IV fluids
Vasopressors
Central lines
341
General sepsis mortality
50-55% when source unknown
342
4 Gram positive anaerobes
CAPP
Actinomyces
Clostridia
Peptostreptococcus
Propionibacterium
343
4 Gram negative anaerobes
Bacteroides
Fusobacterium
Prevotella
Porphyromonas
344
3 common infections caused by actinomyces
Head and Neck infections, Intra-abdominal infections, Aspiration pneumonia
345
2 common infections caused by peptostreptococcus
Oral infections and Intra abdominal infections
346
3 Infections under one umbrella caused by propionibacterium
Foreign Body infections
- Prosthetic join
- Cardiac device
- Shunts
347
3 common signs of a gram positive anaerobic infection
Foul Purulent Abcess
'Spongy tissue
Necrotic tissue
348
3 CXR signs of gram positive anearobic infection
Infiltrates with or without cavitation
Lucency of infiltrates, suggesting tissue necrosis
Abnormal air/fluid levels within circumscribed infiltrate
349
Time required for anaerobic sensitivity testing
Can take up to a week
350
Treatment for Gram positive anaerobic infections
Drain and debride abcess
for throat and neck - clindamycin, Augmentin, Unasyn
For GI/Pelvic - Moxifloxacin PO OR Ertapenem, ceftriaxone, metronidazole IV
Severe - Imipenem
351
Treatment for a gram positive anaerobic lung abscess (3)
Beta lactam with betalactamase inhibitor (ie, ampicillin/sulbactam (Unasyn)
Or carbapenem
Or Clindamycin
352
Treatment for gram positive anaerobe aspiration Out and In patient (2 each)
Outpatient ; Augmentin or Doxycycline
Inpatient ; Beta lactam with beta-lactamase inhibitor OR metronidazole with amoxil or PCN-G
353
Gram positive anaerobic prophylaxis for
Dental procedures
Endocarditis
Colorectal sugery
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
5 Clostridial Infections
Perfringens
Sepcium
Tetani
Botulinum
Difficile
355
Three diseases caused by Clostridium perfringens
Cellulitis, myositis, clostridial myonecrosis
Typically occurs after an injury that has devitalized tissue
356
5 signs and symptoms of a clostridium perfringens infection
Pain, edema, erythema, crepitus from gas formation, foul smell
357
Time to culture for clostridia generally
About 6 hours
358
Treatment for clostridial soft tissue infection
3 - One pharm treatment
Drainage and debridement
Pip/Taz plus clindamycin
Hyperbaric therapy
359
C. perfringens gastroenteritis
Mild gastroenteritis with watery diarrhea. Vomiting and fever not usual. Lasts about 24 hours - self limiting
360
Transmission for C. tetani
After injury via wounds or burns, also IV drug use
361
Pathophysiology and incubation of tetanus
Causes irreversible muscle contraction at nerve endings, 5-30 day incubation period
362
4 symptoms of tetanus
Jaw stiffness, Difficulty swallowing, tonic muscle spasms, Respiratory failure
363
5 elements of care for tetanus
Respiratory Care
Drugs for muscle spasms
Tetanus immune globulin within 24 hours
Vaccination
PCN or metronidizole
364
Clinical presentation of botulism
Dry mouth, slurred speech, dysphagia, drooping eyelids - leading to respiratory failure
Onset in 18-36 hours preceded by N/V/Cramps
365
Treatment for botulism
Respiratory care, NG tube/GI care, Antitoxin
PCN or metronidazole for wound botulism
366
Clinical presentation of C. diff
Typically begins 5-10 days after antibiotic use
Diarrhea, watery or bloody stool, abdominal cramping, tenderness and bloating
N/V is rare
367
How does C diff damage the gut?
It causes cells to become inflamed and eventually burst
368
C. diff diagnosis
Stool sample for toxin, fecal leukocytes, sigmoidoscopy looking for pseudomembranes (if strongly suspected with negative culture), Imaging also an option
369
C. diff treatment
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
6 characteristics of a gram negative anaerobic infection
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
Treatment for gram negative anaerobes
2 steps and 2 drug regimens based on location
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
3 organisms usually involved in bacterial vaginosis
Gardnerella
Prevotella, Peptostreptococcus, or bacteroides
Mycoplasma and Ureaplasma urealyticum (not anaerobes)
373
Presentation of bacterial vaginosis (4)
Grayish vaginal discharge, fishy smell, elevated vaginal pH, Clue cells on microscopy
374
"whiff" test
Vaginal secretions are mixed with KOH which alkalizes amines produced by anaerobic bacteria creating a sharp fish odor
375
Clue cells
Vaginal cells wiht bacteria stuck to them as seen on microscopy
376
3 antibiotics for bacterial vaginosis
Metronidizole (oral or vaginal), Clindamycin (oral or vaginal), Tinidazole (oral)
377
Three atypical bacteria that cause pneumonia
Mycoplasma, Legionella, Chlamydia
378
Pathogenesis and Epidemiology of Mycoplasma
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
5 Signs/Symptoms of Mycoplasma
Mild or "walking" pneumonia, Non consolidated CXR, Bullous maryngitis, Cough, Scant sputum
380
Diagnosis of mycoplasma
Diagnosed via NP swab, typically diagnosis is clinical, patchy infiltrates rather than consolidation on CXR
381
Antibiotic of choice for mycoplasma CAP
Azithromycin
382
3 types of chlamydia
Trichomatis - STD
Psittaci - Birds
Pneumoniae - What is sounds like
383
Presentation and treatment of Chlamydia pneumoniae
Second MCC of walking pneumonia - also treat with Azithromycin
384
Chlamydia Psittaci
Atypical pneumonia from fever, chills, cough, HA
Results from contact with birds
Treat with tetracycline or erythromycin
385
Clinical manifestations of Chlamydia Trachomatis
3 for females, 3 for males, 2 for both
Female - Cervicitis, urethritis, PID
Male - Urethritis, epididymitis, prostatitis
Both sexes - Conjunctivitis, lymphogranuloma venereum
386
Transmission of chlamydia trachomatis
Direct inoculation with infected genital secretions
387
5 Female clinical presentations of Chlamydia
Mucopurulent discharge, Inflamed friable cervix, Pelvic pain, dyspareunia, and cervical motion tenderness
388
3 Male clinical presentations of Chlamydia
Mucoid/watery urethral discharge, Dysuria, Epididymitis - testicular pain
389
4 complications from chalmydia
Pregnancy complications, Infertility, Transmission to newborn, Perihepatitis (Fitz Hugh-Curtis syndrome)
390
Perihepatitis
Inflammation of the liver capsule
391
2 treatments for chalmydia
Doxycycline for 7 days or a 1 time Zmax shot
392
3 spirochetes that cause disease
Treponema pallidum, Borrelia, Leptospira
393
Agent, Transmission and incubation of syphillis
Treponema pallidum
Transmitted by direct contact with infectious lesion during sexual activity
21 day incubation period
394
5 stages of syphillis
Primary, Secondary, Tertiary, Neuro, Latent
395
Primary syphillis
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
Diagnosis and Treatment of syphillis
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
Onset and manifestation of secondary syphillis (5 manifestations)
6 months after chancre
Generalized maculopapular rash, Condyloma lata (genital warts), Generalized LAN, Arthritis, Mucous membrane patches and ulcers
398
Latent syphillis
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
Tertiary Syphilis
Timing and 1 major symptom
Can occurs years after initial infection - delayed hypersensitivity response
Gummas or infiltrative tumors of the skin bones and internal organs (liver)
400
Neurosyphilis
Complication that can occur at ANY stage of the disease but is most common in late syphilis
401
Disease course of neurosyphilis - 4 stages
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
Lyme disease reservoir and vector
Reservoir in deer, transmitted by Ixodes tick
403
1st stage of Lyme disease
Bull's Eye lesion - Erythema migrans within 1 week of tick bite
Flu like symptoms that tend to resolve in 3-4 weeks
404
Stage 2 of lyme disease (5)
Early disseminated infection including
Bacteremia
Secondary skin lesions and rash
Flu-like symptoms
Cardiac problems
Neurologic manifestations
405
Stage 3 of Lyme disease
Late persistent infection months to years afterwards
Musculoskeletal issues
Neurological issues
Skin issues
Self limiting but recurrant
406
Criteria for Lyme diagnosis
A person exposed to a tick bite who:
Developed erythema migrans or had at least one late manifestation
AND
Laboratory confirmation
407
Lab testing for lyme disease (B. burgdorferi)
ELISA and confirm with Western Blot
408
Treatment for Lyme disease
Doxycycline 10-21 days, don't use for longer in children
Amoxicillin (in pregnancy) or Cefuroxime also are options
409
Leptospirosis - Transmission, Presentation, Diagnosis and Tretment
Transmitted from food contaminated by rat urine
Can range from minor to fatal kidney/liver disease
Diagnose via serologic testing
Treat with doxycycline
410
Rocky Mountain Spotted Fever
Caused by Rickettsia ricketsii, Deracentor tick with deer reservoir
73% fatality in the untreated
411
5 states where RMSF is most common
NC, TN, OK, AR, MO
412
Clinical presentation and diagnosis of RMSF
Timing
4 general symptoms
Rash progression
Diagnostic test
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
Medication of choice for RMSF
Doxycycline
414
3 other rickettsia diseases
Typhus, Ehrlichosis, Anaplasma
All produce rash, fever, and myalgia
415
Diarrhea definition (acute, persistent, chronic)
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
3 causes of acute diarrhea
Infectous, Medication, Acute exacerbation of chronic disease
417
7 clues to determine cause of diarrhea
Frequency and amount, Bloodiness, Fever, N/V, Cramps/tenderness/tenesmus, Volume depletion, Immunocompromised status
418
Clinical presentation of inflammatory vs. non-inflammatory diarrhea
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
7 Causes of inflammatory diarrhea (5 bacteria, 1 Virus, 1 Protist)
Bacterial: Campylobacter jejuni, Salmonella, Shigella, EHEC, C. Diff
Virus: Cytomegalovirus
Protist: Entamoeba histolytica
420
9 Causes of Non-inflammatory diarrhea (4 bacteria, 2 viruses, 3 protists)
Bacteria: B. cereus, S. aureus, ETEC, V. cholerae
Viruses: Norovirus, Rotavirus
Protists: Giardia, Cryptosporidium, Cyclospora
421
4 common causes of N/V accompanying diarrhea
S. aureus, B. cereus, Norovirus, Rotavirus
422
1 common cause of diarrheal volume depletion
Vibrio cholerae
423
diarrheal agents common in immunocompromised patients
CMV, Cryptosporidium, Isospora
424
Some common food-foodborne pathogen connections you should know
Beef
Fried rice
Undercooked hamburger
Poultry/Eggs
Shellfish/Raw seafood
PO Antibiotics
Milk/Cheese
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
2 preformed toxin producing diarrheal bacterial w/ onset
S. aureus and B. cereus - 4-6 hours
426
2 Intestinal production toxin producing diarrheal bacteria w/ onset
E. coli and Vibrio - 24 hours
427
3 mucosal invasion bacteria w/ onset
Campylobacter, Shigella, Salmonella
428
Typical onset of viral diarrheal infections
24-48 hours
429
Typical onset of protozoan diarrheal infections
1-2 weeks
430
2 diarrhea related drugs contraindicated in children and pregnant women
Immodium and Pepto Bismol (also don't use pepto bismol in inflammatory diarrhea)
431
4 Lab tests for diarrheal diseases
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
3 aspects of diarrhea management
Fluids and other supportive measures
Antidiarrheals (Loperamide (Immodium), Diphenoxylate, Bismuth (Pepto)
Antibiotics - Cipro or Levaquin most common empiric
433
CSF Tap for Viral vs. bacterial meningitis
Viral is clear
Bacterial is cloudy
434
Cutoff for AIDS
less than 200 CD4 cells per microliter or the presence of an AIDS defining condition
435
6 bodily fluids that do NOT usually transmit HIV
Saliva, Sweat, Tears, Vomit, Urine, Nasal secretions
436
MOA of HIV infection into cells
HIV enters a dendritic cell, traffics within the cell and then moves from it into a CD4 cell
437
4 Stages of HIV infection
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
4 parts of acute HIV infection
Viral penetration of mucosal epithelium
Infection spreads to Monocytes, dendritic cells, and CD4 cells
Infection spreads to lymph nodes
HIV viremia
439
2 Types of macrophages that can harbor HIV making hard to combat
CD-14 and CD-16
440
2 medical history aspects to consider for HIV
Transfusions, needle stick exposure
441
3 social history components to consider for HIV
Sexual orientation, number of partners, drug use
442
4 Physical exam components to consider for HIV
HEENT, lymph nodes, abdomen, skin
443
5 Labs to consider for HIV - Think General
HIV testing, CBC, CMP, screening for STDs, Urinanalysis
444
ART
Antiretroviral therapy
445
Monitoring of the HIV+ patient
CD4 count and HIV Viral load should be monitored every 3-6 months
All patients should be offered ART regardless of CD4 count
446
ELISA testing for HIV
can lead to false positive if too close to the inoculation event - confirm with second ELISA or a western blot
447
Rapid HIV test
Quick results but need to be confirmed
448
Serum p24 test
Tests serum for protein associated with HIV replication
449
PCR test for HIV
CAN diagnose HIV during initial window - used for infant HIV testing
450
Abicavar
HIV drug that can ONLY be used if one tests negative for human leukocyte antigen B15701
451
Truvada
Pre-exposure prophylaxis for HIV (PrEP) combine with behavioral changes to prevent new infections
452
Pregnancy and HIV
Always test for HIV in pregnant women
Initiate ART and consider C-section for HIV+ mothers
Advise NOT to breast feed after birth
453
3 ways HIV can pass from mother to child
during pregnancy
during vaginal childbirth
through breastfeeding
454
Effect of PrEP on HIV transmission for Gay men and Drug users
90% decrease for Gay men
75% decrease for drug users
455
HIV and Tuberculosis
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
What to look for on a CXR for TB
Upper lobe consolidations with or without mediastinal or hilar adenopathy
457
4 things to avoid when having HIV
Raw meat eggs or shellfish (toxo, campylobacter, salmonella, Cat litter (Toxoplasmosis), cat scratches (bartonella), Tap water (cryptosporidium)
458
First line ART for HIV in pregnancy
Zidovudine (retrovir)
459
Post exposure healthcare worker prophylaxis (0636)
HIV antibody and viral load testing at baseline, 6 weeks, 3 months, 6 months
ART for 4 weeks
460
Triple therapy for HIV prophylaxis
Tenofovir, Emtricitabine, dolutegravir OR raltegravir
461
HAART (highly-effective antiretroviral therapy)
At least three medications from two different classes to avoid resistance
462
6 classes of HIV drugs
Nucleoside reverse transcriptase inhibitors
Nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Entry/Fusion inhibitors
Integrase inhibitors
463
What make a patient resistant to an antiretroviral drug
Genes, they can be resistant with NO prior exposure to the drug - testing is essential
464
Nucleoside reverse transcriptase inhibitors
Can cause peripheral neuropathy
Often components of a fixed dose combination
Block conversion of VIral DNA to RNA
465
Only nuceotide transcriptase inhibitor and some info about it
Tenofovir (viread)
Can lead to renal failure
Frequently in fixed dose combinations
Blocks conversion of viral DNA to RNA
466
Non-Nucleoside reverse transcriptase inhibitors (NNRTIs
Inhibit reverse transcription and are well tolerated without special monitoring needed. Block conversion of Viral DNA to RNA
467
Characteristics of Protease inhibitors for HIV (4)
Suppress HIV replication, administered as a combination therapy, CYP 450 inhibitors, used to boost other regimens
Block new HIV from maturation
468
2 HIV entry fusion inhibitors
enfuviritide and maraviroc
469
HIV entry/fusion inhibitors facts
Block HIV entry into cells by blocking receptors - add on therapy for patients who have multiple ART resistances
470
Integrase strand transfer inhibitors (INSTIs)
Block HIV enzyme integrase needed for multiplication, allow for a more rapid decrease in viral load versus other regimens
471
HIV integrase function
Inserts HIV DNA into CD4 cell DNA
472
4 Pearls for monitoring ART therapy
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
Advance HIV infection definition
CD4 cell count under 50 cells per microliter
474
Oral canddiasis
Opportunistic infection in HIV patients - pseumembranous plaques in mouth, common even in non-HIV patients
clotrimazole of fluconazole
475
Musculocutaneous candidiasis
Inguinal rash - treat with clotrimazole or ketoconazole cream BID
476
Oral hair leukoplakia
Caused by epstein-barr virus, white leison on lateral tounge that cannot be rubbed off with hairlike projections
Resolves with ART
477
Genital herpes and HIV
General difference, appearance, treatment
More frequent, severe and likely to disseminate with HIV. Small grouped vescles treat for 5-10 days with acyclovir, famciclovir, valaciclovir
478
Herpes Zoster shingles and HIV
Painful, vesicular dermatomal lesions 7-10 day treatment with famciclovir or valacyclovir. Consider vaccine for HIV+ individuals
479
Molluscum Contagiosum
caused by pox virus - umbilicated fleshy papules treated with liquid nitrogen and imiquimod off label
480
AIDS defining diseases (3)
Pneumocystis jiroveci (formerly carinii), Esophageal candidiasis, Karposi's sarcoma
481
Most common cause of pulmonary disease in HIV patients (3)
Community acquired pneumonia caused by:
Pneumococcal pneumonia
H. flu
Pseudomonas
482
Pneumocystis jiroveci
How to detect on a CXR
Most common opportunistic infection seen with AIDS, Fungal and detected on CXR by diffuse or perihilar infiltrates
Fever cough dyspnea, hypoxemia
483
Dx and Tx for P. jiroveci
Dx through sputum staining, usually elevated serum LDH
Treat with Bactrim and prednisone. Prophylax when AIDS begins
484
Esophageal candidiasis
AIDS defining condition caused by C. albicans in most cases
Dysphagia or difficulty swallowing
EGD (scope) diagnosis
Fluconazole treatment
485
Kaposi's Sarcoma
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
Wasting syndrome
In HIV patients results from Anorexia, N/V aleading to decreased caloric intake
Includes malabsorption
Increased metabolic rate
Dispropotionate loss of muscle mass
487
Treatment for HIV related wasting syndrome
ART, Megastrol acetate, steroids, medical cannabis
488
Mycobacterium Avium and AIDS
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
Cryptococcal meningitis and AIDS
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
Cytomegalovirus retinitis
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
Treatment for Cytomegalovirus retinitis
Galacyclovir for 7-10 days and valgancyclovir for 21 days
492
Toxoplasmosis
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
Infection testing and prophylaxis for all HIV CD4 counts
TB annually with prophylaxis
494
Infection testing and prophylaxis for HIV w/ CD4 count under 250
Coccidiomycosis annual with prophylactic fluconazole. DC when over 250 for 6 months
495
Infection testing and prophylaxis for HIV w/ CD4 under 200
Pneumocystis with bactrim prophylaxis. stop when above 200
496
Infection testing and prophylaxis for HIV w/ CD4 under 150
Histoplasmosis - limited data suggest itraconazole prophylaxis DC when CD4 over 150 for 6 months
497
Infection testing and prophylaxis for HIV w/ CD4 under 100 (2)
Toxoplasmosis - bactrim prophylaxis if positive IgG serology DC when over 200 for 3 months
Cryptococcus - Prophylaxis not recommended
498
Infection testing and prophylaxis for HIV w/ CD4 under 50
Mycobacterium avum - check blood cultures prior to treatment, prophylax with Zmax if cultures are negative. DC when CD4 over 100 for 3 months
499
7 opportunistic pathogens to screen for in an HIV+ patient
TB
Coccidomycosis
Pneumocystis
Histoplasmosis
Toxoplasmosis
Cryptococcus
Mycobacterium avum
