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INFECTIOUS DISEASES Flashcards

1
Q

4 classes of beta lactams

A

penicillins
cephalosporins
carbapenems
aztreonam

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2
Q

which of the following is the most accurate infectious disease test?

protein level of fluid
culture
igM level
IgG level
gram stain
tx response
A

culture

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3
Q

bacteria covered by amoxicillin

A

HELPS

h influenzae, e coli, listeria, proteus, salmonella

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4
Q

what are the 4 penicillinase-resistant penicillins?
what are they used for?
what do the NOT treat?

A

oxacillin, cloxacillin, dicloxacillin, nafcillin

used for skin infections (impetigo, cellulitis, erysipelas), osteomyelitis, and staph meningitis/bacteremia/endocarditis

not active against MRSA or enterococcus

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5
Q

when is methicillin the right answer? why?

A

never!

it causes renal failure from allergic interstitial nephritis

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6
Q

what do you combine with piperaicllin or ticarcillin and why?

A

tazobactam or clavulanic acid

which are beta lactamase inhibitors

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7
Q

which of the following covers for MRSA?

nafcillin
cefazolin
pip-tazo
ceftaroline
azithromycin
A

ceftaroline

the only cephalosporin that covers mrsa!

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8
Q

the only abx that cover mrsa are:

A 
vancomycin
daptomycin
ceftaroline
linezolid
tigecycline

+ lesser known: tedizolid, dalbavancin, telavancin

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9
Q

if a case describes a rash to penicillins, the answer is…

if a case describes anaphylaxis to penicillins, you must use…

A

a cephalosporin

a non beta-lactam abx

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10
Q 
rattle the cephalosporins off:
1st gen
2nd gen
3rd gen
4th gen
5th gen
A

1 - cefazolin, cephalexin, cephadrine, cefadroxyl
2 - cefotetan, cefoxitin, cefaclor, cefprozil, cefuroxime, loracarbef
3 - ceftriaxone, cefotaxime, ceftazidime
4 - cefepime
5 ceftaroline

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11
Q

methicillin sensitive really means….

A

oxacillin sensitive

which means cephalosporin sensitive!

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12
Q

2nd gen cephalosporins

A

cefotetan, cefoxitin, cefaclor, cefprozil, cefuroxime, loracarbef

same coverage as 1st gen but more gram - and anaerobes

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13
Q

out of all the cephalosporins, which cover anaerobes?

A

only cefotetan and cefoxitin (2nd gen!)

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14
Q

3rd gen cephalosporins

which covers pseudomonas?

A

ceftriaxone, cefotaxime, ceftazidime

ceftazidime covers pseudomonas

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15
Q

1st line tx for pneumococcus/gonorrhea?

A

ceftriaxone

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16
Q

why do you have to avoid ceftriaxone in neonates?

A

impaired biliary metabolism

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17
Q

4th gen cephalosporins

A

cefepime
better staph coverage
used for ventilator ass. pna and neutropenia/fever

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18
Q

5th gen cephalosporins

A

ceftaroline
covers gram - bacilli and MRSA
NOT pseudomonas

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19
Q

adverse effect of cefoxitin and cefotetan?

A

increase risk of bleeding by depleting prothrombin

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20
Q

how does ertapenem differ from other carbapenems?

A

it does NOT cover pseudomonas

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21
Q

aztreonam

A 
monobactam class
used only for gram - bacilli INCLUDING pseudomonas

no cross reaction with penicillin

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22
Q

which of the following is most likely to be effective for morganella or citrobacter?

tedizolid
dalbavancin
ertapenem
oritavancin
erythromycin
A

ertapenem

good against gram -
morganella and citrobacter are gram -

the other first 4 abx are used for gram + cocci and mrsa
erythromycin has no useful gram - coverage

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23
Q

fluoroquinolones

coverage and uses?

A

-floxacin

gram - bacilli and pseudomonas

best for CAP
ciproflaxacin for cystitis and pyelonephritis

if used for GI, must be combined w meronidazole to cover for anaerobes (exception moxifloxacin)

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24
Q

what is special about moxifloxacin vs other fluoroquinolones?

A

it covers anaerobes

can be used as a single agent for GI/diverticulitis

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25
Q

adverse effects of fluoroquinolones?

A

bone growth abnormalities (kids/pregnancy)

tendonitis/achilles rupture

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26
Q

adverse fx from aminoglycosides?

A

ototoxicity

nephrotoxicity

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27
Q

nitrofurantoin has 1 use…

A

cystitis in pregnant women

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28
Q

doxycycline
uses
side fx

A

uses: chlamydia, limited Lyme, ricketsia, mrsa, syphilis for penicillin allergic, berrelia, erlichia

side fx: tooth discoloration, photosensitivity, Fanconi (type 2 RTA), esophagitis/ulcer

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29
Q

trimethoprimsulfamethoxazole
mechanism?
uses?
side effects?

A

mech: folate antagonist
uses: cystitis, pneumocystis pneumonia tx and ppx, mrsa cellulitis

fx: bone marrow suppression, hemolysis (in those with G6PD deficiency), and rash

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30
Q

in general, which abx class has highest efficacy?

A

penicillins

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31
Q

linezolid can cause reversible….

A

bone marrow toxicity

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32
Q

Px with perforated bowel, fever and hypotension; anaerobic culture growing an organism; which is most appropriate to start while waiting for results?

aztreonam
pip-tazo
oxacillin
cefepime
doxycycline
vancomycin
A

pip tazo

only one that covers anaerobes from the list

all beta lactam/lactamase inhibitor combos cover for anaerobes with equal efficacy to metronidazole

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33
Q

do carbapenems cover GI tract?

A

YES, they cover gram - bacilli and anaerobes

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34
Q

preferred abx for anaerobes

  • above the diaphragm?
  • Abdominal/GI?
A

above: penicillin (G, VK, ampicillin, Amoxicillin) or clindamycin
below: metronidazole or betalactam/lactamase combos

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35
Q

which is best for e coli bacteremia?

vancomycin
linezolid
quinolones, aztrenam, aminoglycosides, carbapenems, pip/tic
doxycycline
oxacillin
clindamycin
A

quinolones, aztrenam, aminoglycosides, carbapenems, piperacillin, ticarcillin

ALL COVER GRAM - BACILLI
the others dont

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36
Q

what is the most likely diagnosis:

1) meningeal signs in AIDS px with <100 CD4
2) camper/hiker, targetoid rash, joint pain, facial palsy, +/-tick
3) camper/hiker, migratory rash, +/-tick
4) adolescent with petechial rash

A

1 - cryptococcus
2 - lyme dz
3 - rickettsia (rocky mtn spotted fever)
4 - neisseria

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37
Q

for meningitis, the best and most accurate initial test is…

A

Lumbar puncture

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38
Q

what will LP show (cell count, protein, glucose, culture)

1) bacterial meningitis
2) cryptococcus, Lyme, rickettsia
3) TB
4) viral

A

1 - 1000s neutrophils, high, low, often +
2 - lymphocytes, possible high, possibly low, negative
3 - lymphocytes, very high, maybe low, negative
4 - lymphocytes, normal, normal, negative

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39
Q

for meningitis, when is head CT the best initial test?

A

necessary BEFORE LP only if there is chance of a space occupying lesion that may cause herniation
aka when these signs are present:
papilledema (blurred disc margin d/t intracranial P)
seizures
focal neuro deficits
confusion interfering with neuro exam

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40
Q

if there is contradiction to immediate LP, what is best initial step?

A

give abx (better to treat and decrease accuracy of test, than to risk permanent brain damage)

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41
Q

when is a bacterial antigen test (latex agglutination) indicated?

A

if +, extremely specific
if -, doesnt rule ifx out (not sensitive enough to exclude)

use when patient has received abx prior to the LP and culture might be falsely negative

advantage is that this test will not become negative after a few doses of abx!!

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42
Q

What is the most accurate test for TB?

A

acid fast stain and culture on THREE CENTRIFUGED LPs

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43
Q

what is the most accurate test for lyme/rickettsia?

A

specific serology, elisa, PCR, western blot

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44
Q

what is the most accurate test for cryptococcus?

A

CULTURE (100 % specific)

cryptococcal antigen is >95% sens/spec
india ink is only 60-70%

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45
Q

if patient is confused and cant do neuro exam, which do you get first: LP or CT?

A

CT

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46
Q

best treatment for bacterial meningitis?

A

vancomycin, ceftriaxone, and steroids (dexamethasone)

**add ampicillin if immunocompromised for listeria

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47
Q

additional management for neisseria meningitidis?

A

respiratory isolation
and
ppx to close contacts (those with resp fluid contact, to decrease nasopharyngeal carriage) = rifampin, ciproflaxacin, or ceftriaxone

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48
Q

a man comes to the ED with fever and meningeal signs with specific neuro deficit on exam; what is next step?

A

TREAT with ceftriaxone, vanc, and steroids

since there in an immediate contraindication to LP, abx come first BEFORE CT

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49
Q

most common cause of encephalitis (acute onset fever and confusion)?

A

herpes simplex

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50
Q

what is the most accurate test for herpes encephalitis?

pcr of csf
brain biopsy
mri
viral culture of csf
tzanck prep
serology IgG igM
A

PCR of CSF

it is better than biopsy, serology will be + for most so useless, tzanck prep is first test for genital ulcer, viral culture is most accurate for skin lesions but not for csf/brain

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51
Q

first step in encephalitis evaluation?

best initial therapy?

A

CT due to presence of

acyclovir (since it is IV form)
foscarnet can be used for acyclovir resistant forms

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52
Q

woman admitted for herpes encephalitis confirmed by PCR, after 4 days of acyclovir her Cr begins to rise – what is next step?

A

reduce dose and hydrate

do not switch to foscarnet because it only has worse renal toxicity, do not switch to famciclovir or valacyclovir because oral abx is insufficient

53
Q

which is the most sensitive physical finding for otitis media?

A

immobility – mobile TMs basically exclude otitis media

54
Q

what is the most accurate test for otitis media?

what is the best initial tx? next tx?

A

tympanocentesis (if multiple recurrences or unresponsive to tx)

amoxicillin –> amox/clav, azitrhomycin, clarithromycin, cefuroxime, or guinolones(NOT in kids)

55
Q

a 34 yr old woman with facial pain, discolored nasal discharge, bad taste in mouth, and fever….what is most accurate diagnostic test?

sinus biopsy or aspirate
ct scan
xray
culture of discharge
transillumination
A

sinus biopsy or aspirate!

NEVER do a culture of nasal discharge

usually only needed however in recurrence or when unresponsive to tx

56
Q

a 34 yr old woman with facial pain, discolored nasal discharge, bad taste in mouth, and fever….what is next appropriate step?

linezolid
ct scan
xray
amox/clav and decongestant
erythromycin and decongestant
A

amox/clav and decongestant

when dx is clear, ct is unecessary
erythromycin doesnt cover strep pneumo well
linezolid wouldnt cover h influenzae

57
Q

best initial test for pharyngitis (pain swallowing, exudate, fever, no cough)?

tx?

A

rapid strep test
(group A beta hemolytic strep)

penicillin or amoicillin

  • -rash treated with cephalexin
  • -anaphylaxis –> use clindamycin or macrolide instead
58
Q

pharyngitis with membranous exudate?

A

diphtheria

59
Q

influenza tx

A

if less than 48 hrs of sx: oseltamivir or zanamivir (neuraminidase inhibitors to shorten duration)

if more than 48 hrs, sx treatment only (analgesic, rest, hydration, antipyretic)

60
Q

infectious diarrhea - best initial test?

most accurate test?

A

stool lactoferrin has highest senx/spec

second best is fecal leukocytes

most accurate = stool culture

61
Q

causes of infectious diarrhea when there is blood or WBCs in stool:
1 poultry?
2 most common cause?
3 associated with HUS?
4 shellfish and cruise ships?
5 shellfish, hx of liver dz, skin lesions
6 associated with iron, hemachromatosis, blood transfusions
7 white and red cells in stool?

A 
1 salmonella
2 campylobacter
3 e coli 0157:H7 and shigella
4  vibrio parahaemolyticus
5 vibrio vulnificus
6 yersinia
7 clostridium dificile
62
Q 
causes of infectious diarrhea when there is NOT any blood or WBCs in stool?
1 associated with vomiting?
2 vomiting after rice?
3 ADIS <100 cd4
4 unfiltered water while camping
5 nonbacterial
A 
1 staphylococcus or bacillus cereus
2 bacillus cereus
3 cryptosporidiosis
4 giardia
5 viral
63
Q

scombroid poisoning
sx?
tx?

A

rapid onset diarrhea, wheezing, flushing, rash
found in fish
tx w antihistamines

64
Q

which is most accurate in finding the etiology of infectious diarrhea?

hx of eating chicken
frequency
blood in stool
odor
recent interstate travel
A

blood in stool

tells us it is invasive (shigella, salmonella, yersinia, or e coli)

65
Q

specific tx for infectious diarrhea:

1) giardia
2) cryptosporidiosis
3) viral
4) b cereus/staph

A

1 - metronidazole
2 - treat AIDS and nitazoxanide
3 - fluids
4 - fluids

66
Q

which hepatitis is dependent on ifx by hep B?

A

hep D

67
Q

which hepatitis is the worst in pregnancy?

A

hepatitis E

68
Q

which hepatitis is passed via water/food?

via blood/sex/perinatal?

A

A and E

B,C,D

69
Q

in hepatitis, which best correlates with increased likelihood of mortality?

bilirubin
prothrombin time
ALT
AST
Alk phos
A

prothrombin time

increases risk of fulminant hepatic failure and death

70
Q

serology patterns for hep B:

1) acute or chronic ifx
2) resolved or old ifx
3) vaccination
4) window period

A

1 + surface antigen, + e antigen, +IgM or IgG core antibody, - surface antibody
2 - for surface antigen and e antigen, + igG core antibody, + surface antibody
3 - for surface and e antigen, - for core antibody, + for surface antibody
4 - for surface and e antigen, - for surface antibody, + for IgM and then IgG core antibody

71
Q

which of the following becomes abnormal FIRST after acquiring Hep B?

bilirubin
e antigen
surface antigen
core igM antibody
alt
e antibody
A

surface antigen

= a measure of actual viral particles

72
Q

histoplasma capsulatum

A

dimorphic fungi
soil/bat droppings in mississippi and ohio
granulomas, hilar adenopathy

can imitate sarcoidosis; will deteriorate after immunosuppressive therapy

73
Q

Which hepB marker most closely correlates w amount or quantity of active viral replication?

A

e antigen

correlates w amount of Dna polymerase

74
Q

what indicates that a px is no longer a risk for transmitting hep B ?

A

no surface antigen

even if antbody is present, as long as surface antigen is there - there is a chance of active replication

75
Q

what hep B marker indications need for treatment with antiviral?

A

e antigen

= level of polymerase

surface antigen indicates active replication but not wether it is resolves or building up

76
Q

which acute hepatitis has medical tx available?

what is it?

A

acute hepatitis c –> tx with interferon, ribavirin, and either telaprevir or boceprevir

77
Q

how often does hep B become chronic?

chronic is defined by…

A

10%

surface antigen for more than 6 months

78
Q

interferon is rarely used as first line for chronic hepatitis, why?

what is better?

A

it is an injection with lots of side effects: arthralgia, myalgia, leukopenia, thrombocytopenia, depression, flu like sx

sofosbuvir

79
Q

if you are going to treat hepatitis based on viral load, do you need to do a liver biopsy?

A

no

80
Q

cervical discharge + strawberry cervix

dx?
tx?

A

cervicitis

dx: with swab/NAAT
tx: ceftriaxone and azithromycin

81
Q

lower abdominal pain, tenderness and cervical motion tenderness +/-fever, leukocytosis

next appropriate step?
dx?
tx?

A

PID

next step: exclude pregnancy
dx: cervical swab (**laparoscopy is most accurate test however; used when unclear/recurrent)

tx: treat for chlamydia/gonorrhea

82
Q

for patients with penicillin anaphylaxis, how do you treat PID (chlamydia/gonorrhea)?

A

levofloxacin and metronidazole as outpatient
or
clindamycin, gentamicin, and doxycycline as an inpatient

83
Q

most likely STD?

1) painLESS ulcer
2) painFUL ulcer
3) LNs tender and supurative
4) vesicles prior to ulcer and painful

A

1 syphilis
2 chancroid (haemophilus ducreyi)
3 lymphogranuloma venereum
4 herpes simplex

84
Q

best initial test for herpes simplex?

most accurate test for herpes simplex?

A

best initial = tzanck prep

most accurate = viral culture

85
Q

treatment for

1) syphilis
2) chancroid (haemophilus ducreyi)
3) lymphogranuloma venereum
4) herpes simplex

A

1 single dose IM benzathine penicillin (or doxycycline if allergic)
—for tertiary (neurosyph) –> IV penicillin (desensitize if allergic or pregnant)
2 single dose azithromycin
3 doxycycline
4 oral acyclovir (valacyclovir/famciclovir) or foscarnet for acyclovir resistant herpes (topical is worthless)

86
Q

woman comes in with multiple painful genital vesicles…next step in management?

A

acyclovir orally

tzanck prep/diagnostic testing is not needed if the presentation is clear

87
Q

differentiate between primary, secondary, and tertiary syphilis?

A

primary = painless genital ulcer with heaped up indurated edges and painless adenopathy

secondary = rash on palms and soles, alopecia areata(patchy hair loss), condyloma lata

tertiary = neurosyphilis

  • –memory/personality change
  • –argyll robertson pupil (reacts to accomodation but not light)
  • –tabes dorsalis (loss of position and vibratory, incontinence, and cranial nerves)
  • –aortitis (aortic regurg, aneurysm)
  • –gummas (skin and bone lesions)
88
Q

sensitivity of vdrl/rpr versus fta-abs for syphilis?

A

vdrl/rpr
75-85% in primary, 99% in secondary, and 95% tertiary

fta-abs (treponemal abs) IS HIGHER
95% in primary, 100% in secondary, and 98% in tertiary

89
Q

which is the most sensitive test of csf for neurosyphilis?

A

FTA
nearly 100% in csf
a negative fta of csf effectively excludes neurosyphilis
negative fta = NOT neurosyphilis

90
Q

what factors can cause a false positive vdrl/rpr?

A 
infection
old age
injection drug use
AIDS
malaria
antiphospholipid syndrome
endocarditis
91
Q

what is the jarisch-herxheimer reaction and how do you treat?

A

fever and worse sx after treatment (due to endotoxin like products from organism death)
–seen with syphilis

give aspirin and antipyretics…it will resolve on its own!

92
Q

treatment for pregnant women with neurosyphilis?

A

desensitive and then give IV penicillin

93
Q

treatment for crabs or scabies?

A

permethrin

(lindane is equal in effectiveness but more toxic)

94
Q

condyloma acuminata

causative agent?
how to dx?
tx?

A

genital warts (papillomavirus)

dx SIMPLY BY VISUAL APPEARANCE (no biopsy or culture)

tx: cryotherapy or imiquimod (immunostimulant that doesnt damage skin)

95
Q

treatment for cystitis?

A

nitrofurantoin x3 days (7 days if there is anatomic abnormality)

avoid ciprofloxacin to avoid resistance

96
Q

first line tx for pyelonephitis?

A

ceftriaxone

or amp/gent or ciprofloxacin

97
Q

man with pyelonephritis was treated but has persistent fevers 7 days later…next step?

A

imaging like sonogram or CT

most likely a perinephric abscess

then you would DRAIN it

98
Q 
intiial tx for endocarditis?
then specific tx for these bugs:
1 viridans step
2 staph aureus
3 fungal
4 staph epi or resistant staph
5 enterococci
A

vanc and gent initially

1 ceftriaxone 4 weeks
2 oxacillin or nafcillin
3 amphotericin and valve replacement
4 vancomycin
5 amp and gent
99
Q

culture negative endocarditis dx criteria
1 major
3 minor

usual causes? tx?

A

1 oscillating vegetation on echocardiography
2 fever>100.3
3 risks like prosthetic valve or IV drug use
4 signs of embolic phenomena

HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella) or coxiella or bartonella

ceftriaxone

100
Q

if endocarditis culture returns as strep bovis or clostridium, next step?

A

colonoscopy

colon pathology likely!

101
Q

single strongest indication of surgery in patients with endocarditis?

A

CHF from acute valve rupture

102
Q

reasons for surgical intervention for endocarditis?

A 
fungal
CHF from acute valve rupture
prosthetic valves
recurrent emboli while on abx
abscess
AV block
103
Q

best ppx for endocarditis prior to surgery?

A

amoxicillin

104
Q

most common joint affected in lyme?
most common neuro sx in lyme?
most common cardiac sx in lyme?

A

knee

bell palsy (7th CN)

transient AV block

105
Q

dx for lyme dz

A

if rash is typical targetoid erythema migrans, do not need to confirm with serology –> just treat

if no classic rash, do serology with IgM/G, elisa, western blot, or pcr

106
Q 
lyme tx
1_ asx tick bite
2 - rash
3 - joint sx and bells palsy
4 - cardiac and neuro other than bells
A

1 no tx
2 doxycycline
3 doxycycline
4 IV ceftriaxone

107
Q

HIV is what kind of virus? and infects what?

A

retrovirus

CD4 (t helper) cells

108
Q

other than mother to child transmission, which risk factor for HIV has highest risk of transmission?

A

RECEPTIVE anal intercourse

109
Q

In HIV patients, OI that occurs with CD4 count

1) <500
2) <200
3) <100
4) <50

A

1 - oral candidiasis, kaposi sarcoma
2 - PCP(pneumocystis pna), PML(prog. multifocal leukoenceph.)/JC virus, cryptosporridium diarrhea
3 - toxoplasmosis, diss. histoplasmosis, candida esophagitis
4 - cryptococcal meningitis, CMV retinitis, diss. MAC

110
Q

best initial test for HIV?
confirmed with?

best initial for infants?

how to monitor response?

A

elisa test
confirm with western blot

best initial for infants is pcr or viral culture because elisa is unreliable in baby(maternal HIV ab maybe present for 6 months)

pcr -rna level is also used to monitor response

111
Q

best ART combo for HIV?

A

emtricitabine + tenofovir + efavirenz
(E and T are nuceloside reverse transcriptase inhibitors)
(efavirenz is a non nuceloside RTI)

**3 drugs from atleast 2 classes

112
Q

in ART therapy for HIV, which protease inhibitor can be used with other PIs to boost their level?

A

ritonavir (TONES up levels)

113
Q

post exposure prophylaxis for HIV

1) needle sticks and sexual exposure
2) urine and stool exposure?
3) bite from HIV patient

A

1 - YES, 4 weeks of ART
2 - only therapy if there was blood present
3 - yes ART

114
Q

adverse effects of ART meds:

1) zidovudine
2) didanosine/stavudine
3) abacavir
4) protease inhibitors
5) indinavir
6) tenofovir

A

1 - anemia
2 - peripheral neuropathy and pancreatitis
3 - hypersensitivity/Stevens johnson syndrome (HLA B5701)
4 - hyperlipidemia/hyperglycemia
5 - nephrolithiasis
6 - renal insufficiency

115
Q

should ART be continued in pregancy?
c section?
does baby need anything?

A

YES, same regimen, regardless of viral load or cd4 count

except for efavirenz (change to a protease inhibitor), this is teratogenic in animals

if viral load is >1000, do a c section

baby receives zidovudine during delivery and for 6 weeks after birth

116
Q

sporotrichosis

A 
sporothrix schenckii (dimorphic fungus)
decaying plant/soil (gardeners)

skin papules, ulcer with nonpurulent odoless drainage and proximal lesions along lymph chains
dx with culture
tx with oral itraconazole

117
Q

what fungal infection resembles tb but with addition of lytic bone lesions?

dx?
tx?

A

blastomycosis (mississippi/ohio/wisconsin)

broad based budding!

tx itraconazole or amphotericin B

118
Q

OIs with AIDS

bugs and ppx tx

A

<200 PCP, tmp-smx or dapsone
<100 toxo, tmp-smx or pyramethamine/leucovorin
<50 MAC, azithromycin

119
Q

HIV PREexposurePxx

A

tenofovir and emcitirabine (both NRTIs)

120
Q

if PPD is +, next step?

if -?

A

get chest xray!

if -, no further eval - no tb!

121
Q

ppd interpretation

what if ppd has been positive before or active sx?

A

> 5 mm is + for immunocompromised (HIV, close contacts(live at home w person) etc)

> 10 healthcare workers, prison, edemic areas

> 15 average, no risk factors

if ppd have ever been positive or have active sx, you screen with chest xray as INITIAL test

122
Q

how do you treat tb?

A

isoniazid + B6 for latent

active = RIPE - rifampin + b6, isoniazid, pyrazinamine, ethambutol

123
Q

side effects of ripe tx

A

rifampin –> red body fluids
isoniazid –> peripheral neuropathy
p –> hyperuricemia/gout
ethambutol –> eye problems (r/g color blindness)

124
Q

sepsis / SIRS criteria

A 
sirs = 2/4
T <36 or >38
wbc <4 or >12
rr >20
hr >90

septic = sirs + source

severe sepsis = organ dysfunction responsive to fluids

septic shock = unresponsive to fluid

125
Q

where in brain does hsv present?

A

temporal lobe

126
Q

tx for inpatient necrotizing fasciitis (gas in skin on xray/spreading?)

A

debridement then abx

3rd gen cephalosporin + clinda + ampicillin

127
Q

mc cause of osteomyelitis is always

A

staph aureus

128
Q

measles vs german measles(rubella)

which have have arthralgias?

A

rubella!

step 2 ck (16 decks)

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