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Step 2 CK > Infectious Diseases (Infections) > Flashcards

Infectious Diseases (Infections) Flashcards

1
Q

All CNS infections can lead to…

A

Seizures

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2
Q

CNS Infection symptoms: Stiff neck, photophobia, meningismus

A

Diagnosis: Meningitis

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3
Q

CNS Infection symptoms: Confusion

A

Diagnosis: Encephalitis

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4
Q

CNS infection symptoms: Focal neurological findings

A

Diagnosis: Abscess

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5
Q

What are the most common causes of meningitis?

A 
Streptococcus pneumonia (60%)
Group B Streptococci (14%)
Haemophilus influenzae (7%)
Neisseria meningitidis (15%)
Listeria (2%)
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6
Q

What are the differences in presentation between Lyme disease and Rickettsia?

A

Lyme: Rash shaped like a target, joint pain, facial palsy, tick remembered in 20%
Rickettsia: Rash moves from arms/legs to trunk; tick remembered in 60%

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7
Q

What is the best initial and most accurate test for CNS infections?

A

Lumbar puncture

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8
Q

When would you expect to see a CSF evaluation with a cell count in the 1000s and the presence of neutrophils?

A

Bacterial meningitis

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9
Q

When is a head CT necessary prior to LP for CNS infections?

A

When there is a possibility that a space occupying lesion may cause herniation…

  • Papilledema
  • Seizures
  • Focal neurological abnormalities
  • Confusion interfering with neurological examination
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10
Q

What is the best course of action in treating CNS infection when there is a contraindication to immediate LP?

A

Give antibiotics

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11
Q

When is a bacterial antigen test indicated for CNS infection?

A

When the patient has received antibiotics prior to the LP and the culture may be falsely negative

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12
Q

What is the most accurate diagnostic test or the following…
Tuberculosis:
Lyme and Rickettsia:
Cryptococcus:

A

Tuberculosis: Acid fast stain and culture on 3 high volume lumbar punctures
Lyme and Rickettsia: Specific serologic testing, ELISA, western blot, PCR
Cryptococcus: India ink is 60-70% sensitive; Cryptococcal antigen is >95% sensitive and specific (culture is 100% specific)

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13
Q

What is the best initial treatment of bacterial meningitis?

When would you add Ampicillin?

A

Ceftriaxone, vancomycin and steroids

Add ampicillin if immunocompromised for listeria

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14
Q

Listeria is resistant to all ___________

A

cephalosporins

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15
Q

What are the risk factors for listeria (require addition of ampicillin to treatment)?

A 
Elderly
Neonates
Steroid use
AIDs or HIV
Immunocompromised (including alcoholism)
Pregnant
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16
Q

What is given to close contacts of patients with Neisseria meningitidis?
What is meant by “close contacts”

A

Rifampin, ciprofloxacin, or ceftriaxone

Close contacts: Those who have major respiratory fluid contact

17
Q

What is the most common cause of encephalitis?

A

Herpes simplex

18
Q

What is most accurate test of herpes encphalitis

A

PCR of CSF

19
Q

What is the most common neurological deficit of untreated bacterial meningitis?

A

Eighth cranial nerve deficit or deafness

20
Q

What is the best initial therapy for herpes encephalitis?

A

Acyclovir

21
Q

What is used to treat acyclovir-resistant herpes?

A

Foscarnet

22
Q

What is a dangerous side effect of acyclovir and foscarnet?

A

Renal toxicity because the medication precipitates in the renal tubules (foscarnet has more renal toxicity)

23
Q

How does Otitis media present?

A

Redness, immobility, bulging, and a decreased light reflex of the tympanic membrane

24
Q

What is the most sensitive physical finding for otitis media?

A

Immobility (fully mobile tympanic membrane essentially excludes otitis media)

25
Q

What is the most accurate diagnostic test for otitis media?

A

Tympanocentesis for a sample of fluid for culture

26
Q

When is tympanocentesis used in the diagnosis of otitis media?

A

Multiple recurrences or no response to multiple antibiotics

27
Q

What is the best initial therapy for otitis media?

A

Amoxicillin

28
Q

If amoxicillin is ineffective in treating otitis media, what else can be used/added?

A

Amoxicillin/clavulanate
Azithromycin, clarithromycin
Cefuroxime, loracarbef
Levofloxacin, gemifloxacin, moxifloxacin (contraindicated in children)

29
Q

What is the most accurate diagnostic test for sinusitis?

A

Sinus biopsy or aspirate

30
Q

When is a biopsy needed for sinusitis?

A

Infection frequently recurs

There is no response to different empiric therapies

31
Q

What is the presentation of sinusitis?

A

Facial pain, discolored nasal discharge, bad taste in mouth, and fever

32
Q

What are the first-line therapies for both otitis and sinusitis?

A

Amoxicillin/clavulinic acid, doxycycline, and TMP/SMX

a decongestant is also used to promote sinus drainage

33
Q

How does pharyngitis present?

A 
Pain on swallowing
Enlarged lymph node in the neck
Exudate in the pharynx
Fever
No cough and no hoarseness
34
Q

What is the best initial test for pharyngitis?

A

Rapid strep test

35
Q

What type of pharyngitis produces a positive rapid strep test?
What type presents with small vesicles or ulcers?
Membranous exudates?

A

Rapid strep test: Group A beta hemolytic streptococci
Small vesicles/ulcers: HSV or herpangina
Exudates: Diptheria, vincent angina, or EBV

36
Q

How is pharyngitis treated?

A

Penicillin or amoxicillin is the best initial therapy

37
Q

How is pharyngitis treated in penicillin allergic patients (2 answers depending on type of allergic reaction)?

A

Cephalexin if the reaction is only a rash

Clindamycin or a macrolide if allergy is anaphylaxis

38
Q

How does influenza present?

A 
Arthralgias/myalgias
Cough
Fever
Headache and sore throat
Nausea, vomiting, or diarrhea (especially in children)
39
Q

What are the treatment regulations for influenza?

A

Less than 48 hours of symptoms: Oseltamivir, zanamivir; neuraminidase inhibitors shorten duration of symptoms
More than 48 hours: Symptomatic treatment only

Step 2 CK (4 decks)

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