Infectious Diseases Flashcards
Antibiotics for in-patient tx of Community-acquired pneumonia.
Ceftriaxone + Azithromycin
*B-lactam allergy: moxifloxacin
Antibiotics for out-patient tx of Community-acquired pneumonia.
Azithromycin, doxycycline
*B-lactam allergy: moxifloxacin
Antibiotics for healthcare-associated pneumonia.
Vancomycin + Piptazo
or
Linezolid + Meropenem
Key: MRSA or Pseudomona
Antibiotics for Meningitis
Vancomycin + Ceftriaxone 2gr BID + Steroids
*If immunocompromised: Ampicillin
Antibiotics for outpatient UTI
Amoxicillin Or Ampicillin Or Tmp-smx
*If b-lactam allergy: nitrofurantoin
Antibiotic for Pyelonephritis
ceftriaxone
Antibiotic for out-patient strep cellulitis
Amoxicillin
Antibiotic for in-patient strep cellulitis
ceftriaxone
Antibiotic for out-patient staph cellulitis
Clindamycin, cefazolin
Antibiotic for out-patient staph cellulitis
vancomycin
Patient with Flu-like sx, myalgias, arthralgias, lymphadenopathy, fever.
• Flu (-), mononucleosis (-)
• HIV ELISA (-)
Dx, next step, tx?
Antiretroviral syndrome
Next step: PCR (viral load)
Tx: HAART (2+1)
Patient with opportunistic infection, HIV ELISA (+)
Next steps, tx?
Confirmation HIV with western blot
Other tests:
o Viral load (decreases quickly with tx)
o CD4 count (slowly increases only 300 of start point)
o Genotype (“culture”)
o Screen for gonorrhea, chlamydia, syphilis, HBV, HCV, toxoplasma.
Tx: HAART 2+1 depending on genotype
What is HAART 2+1?
2 nucleoside reverse transcriptase inhibitors (NRT-i) plus 1 of the following:
• Non- nucleoside reverse transcriptase inhibitors (NNRT-i)
• Protease inhibitor (P-i)
• Entry inhibitor
• Fusion inhibitor
Meds for PrEP?
Tenofovir + Emtricitabine
Meds for post-exposure prophylaxis (PEP)?
Tenofovir + Emtricitabine +/- Raltegravir
Vertical transmission prophylaxis of HIV?
- Mom on HAART 2+1
* If unknown before: AZT
Prophylaxis of PCP pneumonia in HIV?
- Tmp-smx
- Dapsone
- Atovaquone
Prophylaxis of toxoplasmosis pneumonia in HIV?
- Tmp-smx
2. Pyrimethamine + leucovorin
Prophylaxis of Mycobacterium avium complex (MAC) pneumonia in HIV?
Azithromycin
Tx of Thrush in HIV?
Nystatin
Tx of Pneumocystis (PCP) pneumonia in HIV?
Tmp-Smx, dapsone
Tx of Crypto meningitis in HIV?
Amphotericin + fluticasone
Tx of Esophageal candidiasis in HIV?
Fluconazole
Tx of HSV Esophagitis in HIV?
Acyclovir
Tx of CMV Esophagitis in HIV?
ganciclovir
Tx of Toxoplasmosis in HIV?
Pyrimethamine sulfadoxine
Tx of Disseminated Mycobacterium avium complex (MAC) in HIV?
Clarithromycin + ethambutol
Tx of CMV retinitis in HIV?
Valaciclovir, foscarnet
Patient with close contacts, HIV/AIDS, Transplants, Chemo. How much is a positive PPD?
> 5mm
Prisoners, Homeless, Healthcare worker, Traveled to endemic area. How much is a positive PPD?
> 10 mm
Western patient with no risk factor. How much is a positive PPD?
> 15 mm
TB screening.
+ PPD
- CRx
Dx and next step?
Latent TB
INH + B6 x 9 months
TB screening.
+ PPD
+ CRx
Next step?
AFB smear
TB screening.
+ PPD
+ CRx
- AFB smear
Dx and next step?
Latent TB
INH + B6 x 9 months
TB screening.
+ PPD
+ CRx
+ AFB smear
Dx and next step?
Active TB
RIPE
Young patient with hemoptysis, night sweets, weight loss.
CRx with apical lesions
(+) AFB smear
Dx and next step?
Active TB
RIPE
Young patient with hemoptysis, night sweets, weight loss.
CRx with apical lesions
(-) AFB smear
Dx and tx?
Latent TB
INH + B6 x 9 months
Young patient with hemoptysis, night sweets, weight loss.
Normal CRx
(-) AFB smear
Next step?
Nucleic acid amplification test (NAAT) to rule out TB
Patient with suspicion of TB. culture is initially (-) but then comes back (+) after 6 weeks.
Dx?
Mycobacterium avium complex (MAC)
Side effects of Rifampicin
Red urine and hepatotoxicity
Side effects of INH
Neuropathy (B6 for prophylaxis) and hepatotoxicity
Side effects of Pyrazinamide
Hyperuricemia, gout and hepatotoxicity
Side effects of Ethambutol
Optic neuritis (Eye) and hepatotoxicity
Definition of sepsis
Severe organ dysfunction from dysregulated response to infection
Organ dysfunction is screen with qSOFA > 2 points
- RR > 22
- BP < 100 mmHg
- Altered mental status (GCS < 15)
Criteria of qSOFA?
Organ dysfunction in sepsis is screen with qSOFA > 2 points
- RR > 22
- BP < 100 mmHg
- Altered mental status (GCS < 15)
Definition of septic shock
Sepsis which is NOT responsive to IVFs presenting with:
- Persistent hypotension requiring vasopressors
- Serum lactate > 2 mmol/L
Definition of MODS (multiorgan dysfunction syndrome)
Septic shock + multiple organs failing
Goals of Early goal-directed therapy (management of sepsis)
Early -> Intervene within 6 hours Goals - Central venous pressure 10-12 mmHg - Urinary output > 0.5 cc/kg/hr - MAP > 65 mmHg - Central venous saturation (ScvO2) > 70%
Management of sepsis
- IVFs (bolus of 30cc/kg)
- Empiric antibiotics (e.g., vanco + pip/tazo)
• Get cultures before - Remove potential sources like drainage or plastics (e.g., central lines, endotracheal tubes, foley)
- Oxygen
- RBCs if Hb < 7
- Vasopressors if not responsive to IVFs
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Probable dx and Next step?
Meningitis
Next step: lumbar punction
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows 1000 PMN.
Dx and tx? What would be the tx if immunosuppressed?
Bacterial meningitis
Treat empirically with Ceftriaxone + vancomycin + steroids while the results of Cx come out.
If the patient were immunosuppressed, add ampicillin
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has rash that moves from arms to trunk. The patient was camping recently.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows no significant changes.
Dx and tx?
Rocky mountains spotty fever
Tx: Ceftriaxone
Patient with Fever, Headache, Photophobia, Phonophobia, arthralgias, Nausea and vomiting. On physical exam has a targetoid rash. The patient had a recent trip to Connecticut
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows no significant changes.
Dx and tx?
Lyme disease
Tx: Ceftriaxone
Patient AIDS with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting.
Dx, next step and tx?
Cryptococcal
Next step: cryptococcal antigen
Tx; Amphoericin
Patient (homeless/prisoner) with Fever, Headache, Photophobia, Phonophobia, night sweats, weight loss, hemoptisis Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows no significant changes.
Dx and tx?
Meningitis for TB
Tx: Rifampicin INH Pyrazinamide Ethambutol
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
Altered mental status, suspition of Immunosuppression, history of Seizures. Vitals: HTN, RR: 28, HR: 45.
Probable dx and Next step?
Meningitis
Next step:
- Empiric Abx (Ceftriaxone + vancomycin + steroids. If immunosuppressed, add ampicillin)
- Then, CT scan
Patient HIV (+) with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting.
Probable dx and Next step?
Toxoplasmosis
Next step:
Toxo Ab
Treat toxo and repeat scan in 6 weeks
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
Altered mental status, history of Seizures. Vitals: HTN, RR: 28, HR: 45.
Toxo Ab: Negative
Next step?
Biopsy to distinguis between cancer and abscess.
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows ↑ lymphocites.
Dx, next step and tx?
Encephalitis
HSV PCR
Tx:
- If HSV PCR (+): IV acyclovir
- If HSV PCR (-): Supportive care
Patient with Red, hot, tender skin, Demarcated area with Site of entry. No abscess. Normal vitals.
Dx, microorganism and tx?
Cellulitis
Microorganism: Strep A (no abscess)
Tx: Cefalexin
Mark the edge of the infection and follow its evolution
Patient with Red, hot, tender skin, Demarcated area with Site of entry, abscess. Normal vitals.
Dx, microorganism and tx?
Cellulitis
Microorganism: Staph
Tx: Tmp-smx (PO)
Mark the edge of the infection and follow its evolution
Patient with Red, hot, tender skin, Demarcated area with Site of entry, abscess. The patient looks septic.
Dx, microorganism and tx?
Cellulitis
Microorganism: Staph
Tx: Vancomycin or Linezolid (IV) or Clindamycin
Mark the edge of the infection and follow its evolution
Patient with refractory celullitis. Dx?
Rule out Osteomyelitis
Patient Penetrating Wound with exposed bone. Dx and microorganism?
Osteomyelitis
S. Aureous, pseudomona
Patient with sickle cell with osteomyelitis. Microorganism?
S. Aureous, salmonella
Patient who was gardening and has Osteomyelitis. Microorganism?
S. Aureous, sporothrix
Patient with DM who has Osteomyelitis. Microorganism?
S. Aureous, pseudomona
Patient with cirrhosis who eats Oysters and has hematogenous Osteomyelitis. Microorganism?
S. Aureous, V. vulnificus
Patient with refractory celullitis. Next steps, tx and F/U?
Nest steps:
- 1st X-Ray
- 2nd MRI
- Best: Bx and Cx
Tx:
- Debridement
- 4-6 weeks of antibiotics
- Empirical: Vanco + pip/tazo
F/U: ESR, CRP. If they decrease, transition to PO
Patient penetrating wound contaminated with feces. On physical has Crepitus on skin. Dx, next step and tx?
Gas gangrene
Next step:
- X-Ray shows subcutaneous gas
Tx:
- Debridement
- Penicillin + Clinda
Patient with Refractory rapidly evolving cellulitis, Septic, Pain out of proportion, Crepitus, Blue/gray discoloration. Dx, next step and tx?
Necrotizing fasciitis
Next step:
- X-Ray showing gas
Tx:
- Surgical debridement
- 3rd gen cephalosporin + clinda + ampicillin
Who’s called the Necrotizing fasciitis on the groin?
Fournier’s gangrene
Most common microorganism in Community-acquired pneumonia (CAP)?
S. Pneumo
Most common microorganism in CAP in COPD patient?
H. Influenza
Patient with pneumonia for aspiration. Mos common microorganism?
Klebsiella and anaerobes
Patient who had the flu and then has again cough, fever and consolidation. Microorganism?
S. Aureus
Most common microorganism in CAP in immunosupressed patient?
Legionella
Patient with fever, productive cough. CxR normal. Dx and tx?
Bronchitis
Tx:
Azithromycin or doxycycline or moxifloxacin
Patient with fever, productive cough. CxR with cavitatory lession. Next step?
CT scan to differentiate between Fungus, Cancer, TB and abscess.
If abscess –> ceftriaxone + clinda
Patient with fever, productive cough. CxR with consolidation. > 90 days from exposure to a “healthcare facility”
< 48 hrs from admission to a hospital
Dx and Tx?
Comminuty adquired PNA (CAP)
Tx: 3rd gen cephalosporin \+ Macrolide (Azithromycin) OR Moxifloxacin
Patient with fever, productive cough. CxR with consolidation. < 90 days from exposure to a “building”
> 48 hrs from admission to a hospital
Dx and Tx?
Healthcare associated PNA (HCAP)
Tx:
Pip/tazo or Cephepime
+
Vancomycin
Patient HIV/AIDS with slowly developing SOB and productive cough.
Dx, next step, and Tx?
Pneumocystis (PCP) PNA
Next step:
Silver stain of sputum
Tx:
TMP-SMX
+/-
Steroids (if hypoxemic)
How to define who needs to be admitted in PNA?
CURB-65 (if one is met, they are admitted)
- Confusion of new onset
- Urea > 7 / BUN > 19
- Respiratory rate > 30
- Blood pressure < 90/60
- > 65 years old
Tx of influenza?
Oseltamivir (Tamiflu)
Men with urethral dischrage. Dx, next step and tx?
Urethritis
Next step: Urinary GC/Chlamydia
Tx:
Ceftriaxone 250 mg IM, single dose
+
Azithromycin PO x 1 or doxycyclin PO x 7 days
F/U: HIV screening
Pregnant patient with. Uroanalysis: - Leukocyte Esterase - Nitrites - > 10 wbc/hpf
Dx and tx?
ASx bacteruria
Tx: amoxicillin; nitrofurantoin if PNC allergic
F/U: Repeat the screen
Asx patient, no risk factors. Uroanalysis: - Leukocyte Esterase - Nitrites - > 10 wbc/hpf
Next step?
Nothing
Patient with Urgency, frequency, dysuria. No risk factors. Uroanalysis: - Leukocyte Esterase - Nitrites - > 10 wbc/hpf
Dx, next step and tx?
Uncomplicated cystitis
Next step: nothing, no need for culture
Tx: TMP-SMX x 3 days or Nitrofurantoin x 3 days or Fosfomicin x 3 days
Criteria for complicated cistitis
- Penis (men)
- Plastic (e.g., foley)
- Procedure
- Pyelonephritis
Men with Urgency, frequency, dysuria, and a foley catheter. Uroanalysis: - Leukocyte Esterase - Nitrites - > 10 wbc/hpf
Dx and tx?
Complicated cystitis
Tx: TMP-SMX x 7 days or Nitrofurantoin x 7 days or Fosfomicin x 7 days
When to do a culture in UTI?
- Pregnant
- Procedure
- Pyelonephritis
- Multi-drug resistance
- Abx failure
Positive if > 105 colonies
Patient with Urgency, frequency, dysuria, Fever, chills. On physical exam has costo-vertebral angle (CVA) tenderness.
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf
Dx, next step and tx?
Pyelonephritis
Next step: Culture
Tx:
- IV Ceftriaxone or ampi-sulb if hospitalized x 10 days
- PO ciprofloxacin if ambulatory x 10 days
Patient with pyelonephritis who doesn’t improve after 72 hrs
Dx, next step and tx?
Perinephric abscess
Next step:
- CT scan if non-pregnant
- U/S if pregnant
Tx:
- Drainage
- Continue Abx for 14 days
Patient with singular, painless genital ulcer with nontender lymphadenopathy.
Dx, next step and tx?
Primary Syphilis
Next step: dark field microscopy
Tx: Penicillin x 1 IM
F/U
- HIV screening
Patient with fever targetoid rash involving palms and soles.
Dx, next step and tx?
Secondary Syphilis
Next step: RPR, if positive confirm with FTA-Abs
Tx: Penicillin x 1 IM
F/U
- Repeat RPR–> dilusions have to decrease after treatment
- HIV screening
Patient ASx, (+) RPR, Contraction < 1 year.
Dx and tx?
Early Latent Syphilis
Tx: Penicillin x 1 IM
F/U
- Repeat RPR–> delusions have to decrease after treatment
- HIV screening
Patient ASx, (+) RPR, Contraction > 1 year.
Dx and tx?
Late latent Syphilis
Tx: Penicillin q week x 3 weeks
F/U
- Repeat RPR–> delusions have to decrease after treatment
- HIV screening
Patient with Tabes dorsalis and Argyll-Roberston pupils (bilateral irregular small pupils that accommodate but don’t react to light)
Dx, next step and tx?
Tertiary Syphilis
Next step: Lumbar punction CSF-RPR, if positive confirm with CSF-FTA-Abs
Tx: Penicillin q4h IV x 10-14 days
F/U
- Repeat RPR–> delusions have to decrease after treatment
- HIV screening
Patient with Singular, painless gential ulcer with tender lymphadenopathy.
Dx, next step, tx?
Lymphogranuloma venereum
Next step: NAAT
Tx: Doxycycline
Patient with Singular, painful genital ulcer with tender lymphadenopathy.
Dx, next step, tx?
Chancroid
Next step: Gram stain + culture
Tx: Azithromycin or cipro
Patient with painful vesicles in genitals with erythematous base that tend to coalesce.
Dx, next step, tx?
Herpes
Next step: PCR
Tx: Acyclovir or valacyclovir
Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear.
Dx and next step?
Otitis media
Pneumatic insufflation
Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear.
On physical Pneumatic insufflation, the membrane doesn’t move.
Dx and tx?
Otitis media
Tx:
- 1st: Amoxicillin
- 2nd: Amoxicillin-clavulanate
- Penicillin allergy: Cefdinir, azithromycin
Indications of tympanostomy
3 or more otitis in 6 months or 4 in a year
Patient with Unilateral ear pain, Worse by pulling the pinna.
Dx and tx?
Otitis externa
Tx:
- Spontaneous resolution
- Cipro drops
- Steroid drops
Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear, Swelling behind the ear, Anteriorly rotated ear.
Dx and tx?
Mastoiditis
Tx: Surgical decompression
Patient with more than 10 days of Congestion, Bilateral purulent discharge, Painful facial tap
Bacterial sinusitis
Amoxicillin-clavulanate
Patient with Sore throat, Odynophagia and fever. Cough (+), no exudates, no nodes.
Dx, and tx?
Pharingitis centor 1 (viral)
Centor criteria • no Cough +1 • Exudate +1 • Nodes +1 • ****Temp +1**** • OR < 14 +1; > 44 -1
Tx: Centor >= 1–> viral, supportive tx
Patient with Sore throat, Odynophagia and fever. No cough, no exudates, no nodes.
Dx and next step?
Pharingitis centor 2
Centor criteria • ****no Cough +1**** • Exudate +1 • Nodes +1 • ****Temp +1**** • OR < 14 +1; > 44 -1
Next step: Centor 2-3: Rapid strep (if positive get culture)
Patient with Sore throat, Odynophagia and fever. No cough, exudates, anterior nodes in neck.
Dx and next step?
Bacterial Pharingitis centor 4
Centor criteria • ****no Cough +1**** • ***Exudate +1**** • ****Nodes +1**** • ****Temp +1**** • Age < 14 +1; > 44 -1
Next step: Centor > 4: Amoxicillin-clavulanate
Patietn with pharyngitis + enlarged spleen. Dx?
Mononucleosis
Baby that snores and has cyanosis when eating, pink when crying. Dx and tx?
Choanal atresia
Tx: Surgery
Duke criteria
Major
- Bacteremia (strep, staph, HACEK)
- New regurgitation murmur
- Vegetation on Echo
Minor
- Risk factors: PWID, history of endocarditis, prosthetic valves
- Fever
- Vascular complications (acute limb ischemia; Splinter hemorrhage; Janeway lesions)
- Rheumatologic complications: Roth spots; osler nodes, glmerulonephritis)
Splinter hemorrhage
hemorrhages underneath nails
Janeway lesions
non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles.
Roth spots
retinal hemorrhages
osler nodes
painful red, raised lesions found on the hands and feet
Patient PWID with CHF, Bacteremia and Toxic. Dx and next step?
Acute endocarditis
Next step:
- Blood cultures
- TEE
Tx: Treat until culture negative
Patient with Recurrent fever, with retinal hemorrhages and painful red, raised lesions found on the hands and feet.
Dx, next step and tx?
Subcute endocarditis
Next step:
- Blood cultures
- TEE
Tx:
Genta + ceftriaxone x 4-6 weeks. Start when cultures become positive
Antibiotics for infective endocarditis in native valve?
Vancomycin
Antibiotics for infective endocarditis in new prostetic valve of < 60 days?
Vancomycin + gentamycin + cefepime
Antibiotics for infective endocarditis in prostetic valve of 60-365 days?
Vancomycin + gentamycin
Antibiotics for infective endocarditis in old prostetic valve > 365 days?
Vancomycin + gentamycin + ceftriaxone
Patient with infective endocarditis who’s allergic to vancomycin. How to replace vanco?
Daptomicin
Indications for surgery in infective endocarditis
- Vegetation > 15 mm
- Vegatation > 10 mm + embolization
- Abscess
- CHF
- Fungus
When to give prophylaxis for infective endocarditis?
[Congenital heart disease OR prostetic valve OR history of endocarditis]
AND
[Dental procedure OR bronchoscopy]
Antibiotic for prophylaxis for infective endocarditis?
Amoxicillin
Patient with infective endocarditis whose blood culture is positive for strep bovi. Next step?
Do colonoscopy. Patient highly suspicious of colon cancer
The three most common causes of fever of unknown origin (FUO).
Infection, cancer, and autoimmune disease.
Four signs and symptoms of streptococcal pharyngitis.
Fever, pharyngeal erythema, tonsillar exudate, lack of cough.
A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.
Postinfectious glomerulonephritis.
Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms—pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella.
The number of bacteria on a clean-catch specimen to
diagnose a UTI.
105 bacteria/mL.
Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications.
A patient from California or Arizona presents with fever, malaise, cough, and night sweats.
Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B.
Nonpainful chancre.
1° syphilis.
A “blueberry muffin” rash is characteristic of what congenital infection?
Rubella.
Meningitis in neonates. Causes? Treatment?
Group B strep, E. coli, Listeria. Treat with gentamicin and
ampicillin.
Meningitis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H. infl uenzae. Treat with cefotaxime and vancomycin.
What should always be done prior to LP?
Check for ↑ ICP; look for papilledema.
CSF findings:
■ Low glucose, PMN predominance
Bacterial meningitis
CSF findings:
■ Normal glucose, lymphocytic predominance
Aseptic (viral) meningitis
CSF findings:
■ Numerous RBCs in serial CSF samples
Subarachnoid hemorrhage (SAH)
CSF findings:
■ ↑ gamma globulins
Multiple Sclerosis
Initially presents with a pruritic papule with regional
lymphadenopathy; evolves into a black eschar after 7–10
days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.
Findings in 3° syphilis.
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms.
Characteristics of 2° Lyme disease.
Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis.
Cold agglutinins (a form of autoimmune hemolytic anemia in which cold agglutinins –agglutinating autoantibodies with an optimum temperature of 3 to 4°C–can cause clinical symptoms related to agglutination of red blood cells in cooler parts of the body and hemolytic anemia).
Associated with?
Mycoplasma.
A 24-year-old man presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension or fluconazol.
Begin Pneumocystis jiroveci (formerly P. carinii) pneumonia prophylaxis in an HIV-positive patient at what CD4 count?
Mycobacterium avium–intracellulare (MAI) prophylaxis?
≤ 200 for P. jiroveci (with TMP-SMX)
≤ 50–100 for MAI (with clarithromycin/azithromycin).
Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones.
Neutropenic nadir postchemotherapy.
7–10 days.
Erythema migrans.
Dx?
Lesion of 1° Lyme disease.
Classic physical findings for endocarditis.
Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots.
Aplastic crisis in sickle cell disease.
Microorganism?
Parvovirus B19.
Ring-enhancing brain lesion on CT with seizures.
Taenia solium (cysticercosis).
Name the organism:
■ Branching rods in oral infection
Actinomyces israelii
Name the organism:
■ Painful chancroid
Haemophilus ducreyi
Name the organism:
■ Dog or cat bite
Pasteurella multocida
Name the organism:
■ Gardener
Sporothrix schenckii
Name the organism:
■ Pregnant women with pets
Toxoplasma gondii
Name the organism:
■ Meningitis in adults
Neisseria meningitidis
Name the organism:
■ Meningitis in elderly
Streptococcus pneumoniae
Name the organism:
■ Alcoholic with pneumonia
Klebsiella
Name the organism:
■ “Currant jelly” sputum
Klebsiella
Name the organism:
■ Infection in burn victims
Pseudomonas
Name the organism:
■ Osteomyelitis from foot wound puncture
Pseudomonas
Name the organism:
■ Osteomyelitis in a sickle cell patient
Salmonella
A 55-year-old man who is a smoker and a heavy drinker
presents with a new cough and fl ulike symptoms. Gram
stain shows no organisms; silver stain of sputum shows
gram-negative rods. What is the diagnosis?
Legionella pneumonia.
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy.
What is the likely diagnosis, and how did he get it? Treatment?
Lyme disease, Ixodes tick, doxycycline.
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
