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CCFP EM > Infectious Dz > Flashcards

Infectious Dz Flashcards

1
Q

RF for MRSA

A

hospitalization
indwelling catheter
recent abx
reside in LTC
close contact sports
close living quarters (eg prison)
MSM
IVDU
day care attendance

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2
Q

gram + cocci with mecA gene?

A

MRSA

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2
Q

botulism organism

A

clostridium botulinum

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3
Q

presenting symptoms of botulism and mechanism behind it

A

-often starts with GI symptoms.
descending (ie starting with cranial nerves flaccid paralysis with mydriasis, ptosis, eventual resp paralysis, endo toxin block release of Ach at NMJ

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4
Q

3 broad categories of botulism

A

infant (72%) , food-borne (25%), wound (rare)

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5
Q

test and tx of botulism

A

test: toxin in blood, stool or food or bacteria grown from wound

tx: supportive + immunoglobulin

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6
Q

tetanus organism

A

clostridium tetani

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7
Q

presenting symptom of tetanus

A

spastic paralysis and tetany
due to blockage of inhibitory neurotransmitters.

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8
Q

4 types of tetanus

A

local, generalized, neonatal, caphalic

(say a few things about each), pg 481 FA

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9
Q

ddx for tetansu

A

strychine poisoning –> found in pesticides, homeopathic meds etc. dx is benzos

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10
Q

presenting symptoms of generalized tetanus

A

trismus
sardonic smile
opisthotonus
resp failure

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11
Q

tx of symptomatic tetanus

A

tetanus IG (TIG), 3000 U IM and Td vax at seperate site, dont debride wounds until TIG given
can consider flagyl, but limited evidence

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12
Q

what is a high risk wound for tetanus

A

> 6h old, contaminated (dirt, saliva, feces), puncture, crush, avulsion, fb, burns, frostbite

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13
Q

tetanus wound proh: high risk wound

A

-if 3 or more vax – > update vax >5 years from last dose
-if unknown or 2 or less –? give TIG (250 U IM) and give Tdap

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14
Q

tetanus wound proph: low risk wounds

A

-if 3 or more vax – > update vax >10 years from last dose
-if unknown or 2 or less –update with Tdap

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15
Q

define sepsis

A

is a condition of life-threatening organ dysfunction (such as hypotension, altered mentation, oliguria, & others) due to
a dysregulated host response to infxn (confirmed or suspected)

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16
Q

define septic shock

A

Septic shock is characterized by refractory hypotension & vasopressor requirement (40 mL/kg of crystalloids) to maintain an MAP ≥65 mmHg
& having a serum lactate level >2 mmol/L

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17
Q

1st and secoond pressor in sepsis with doses

A

nor epi : start 0.1 up to max of 0.4 mcg/kg/min

vasopressin: 0.03 U/min

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18
Q

map and urine goals in sepsis

A

65 and >=0.5 ml/kg/hr

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19
Q

qSOFAt is it, how to use it?

A

2 or more of:

RR ≥22
Systolic BP ≤100
Any altered mental status (or Glasgow Coma Scale [GCS] ≤13 if established)

For pt with a diagnosed or suspected infxn, the dx of sepsis should be established by the presence of organ dysfunction as
reflected by a ≥2 points increase from their baseline score in their qSOFA score if they are outside of the ICU (or in the absence of lab data enabling the use of the more detailed
SOFA score)

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20
Q

preffered fluid in sepsis and minimum resucitation in forst 4-6 hours

A

RL and 30 mL/kg

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21
Q

surviving sepsis 3 and 6 hour bundles

A

To be completed within 3 hr of presentation:
1. Measure lactate level
2. Obtain blood cx before abx administration
3. Administer broad-spectrum abx (administer within 1 hr)
4. Administer 30 mL/kg crystalloid (minimum) for hypotension or for lactate >4 mmol/L … USE PRESSORS IF MAP <65 DURING FLUID RESUSCITATION

To be completed within 6 hr of presentation:
1. Apply vasopressors if unresponsive to appropriate fluid resuscitation (goal MAP ≥65 mmHg)
2. If hypotension is sustained after initial fluid resuscitation
a. Measure & follow CVP trend
b. Measure & follow ScvO2
3. 3. If lactate is elevated, remeasure & aim for normalizing lactate

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22
Q

uncomplicated vs disseminated gonorrhea

A

uncomplicated = GU or oropharyngeal infection with no bactermia or ascending infection

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23
Q

2 locations for disseminated GC

A

septic arthritis
tenosynovitis/dermatitis/polyarthalgia syndrome

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24
Q

Tx of uncomplicated and disseminated GC

A

uncomp: Ctx 250 IM X1 or cefixime 800 po X1

comp: CTX 1 g IV

+ in both cases treat for chalmydia!!! azithro 1g X1

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25
Q

stages of syphillis

A

-primary: painless chancre on genitals
-secondary: maculopapular rash (palms and soles); condylomata lata (wart like genital lesions)
-latent: asymptomatic
-tertiary–. gummotous MM lesions
-neurosyphillis:

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26
Q

tests for syphillis

A

VDRL or RPR are screening tests, but have false +,

confirm with florescent treponema antibody test (stays positive for life)

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27
Q

Jarisch-Herxheimier reaction

A

fever that lasts 12 hours, self-limited, occurs with tx of spirochete infection, worse in HIV pt

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28
Q

tx of syphillis

A

primary/secondary: PCN 2.4 million unit IM X1

tertiary/latent: same but longer course, weekly X3 doses

neurosyph: IV PCN

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29
Q

%age of ppl with monoantibodies vs %age of ppl with clinical infection

A

> 90%, about 10%

most pediatric infections are asymptomatic

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30
Q

s/s of mono/EBV infection

A

sore throat, fever, myalgias

pharyngitis, cervical adenopathy and hepatosplenomegaly.

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31
Q

how long to avoid contact sports in mono

A

4 weeks

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32
Q

dosing of rabies prophylaxis: RIG and vaccine

A

vaccine: 4 doses IM on day 0, 3, 7, 14 and on day 28 if immunocomp

RIG 20 U/kg, infiltrate as much as possible at site of bite. rest is given IM at site distant from vaccine

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33
Q

bat exposure with no known bite?

A

prophylaxis is recommended

34
Q

Rabies post exposure prophylaxis

A
35
Q

Rose Gardner’s disease?

A

sporotrichosis, fungal infection, occurs 3 weeks after inoculation of wound in soil/on plants. presents with suppurative nodules on skin that progress proximally along lymphatic channels

can progress to systemic disease (rarely), tx is antifungal

36
Q

most common helminth infection, symptoms and treatment

A

pinworms, perianal itching, can dx with scoth tape, tx is mebendazole

37
Q

loeffler syndrome

A

pneumonitis and pulm symptoms (eg cough and wheeze) from worm migration to lungs

38
Q

timeframe to think about infections in transplant patients

A

first month, 1-6 months, > 6 months

39
Q

types of infections in first month for transplant pt (3)

A
  • donor related (rare due to pre-screen)
    -recipient re-activation (pseudomonas, TB, aspergillus)
    -regular hospital acquired/peri-op infections
40
Q

types of infections months 1-6 for transplant pt (2)

A

-reactivation of previously latent infection (especially CMV, EBV, VZV)
-opportunistic infections

41
Q

how does CMV present in transplant pt

A

pneumonitis, GI symptoms, renal injury, skin manifestations or CNS infection

42
Q

infections in transplant pts after 6 months

A

lowest risk period, they are at slightly increased risk for typical community acquired infections, esp pma. CMV also always a consideration

43
Q

diseases in needlestick injury

A

HIV, HepB, HepC and bacterial infections

44
Q

BW for needlestick: source person

A

if they consent: HepB surface Ag, HepC antibody and HIV

45
Q

BW for needlestick: person who got poked

A

HepB surface ANTIBODY, anti HCV Ag and HIV

46
Q

Hep C needlestick protocol

A

no vaccine or prophylaxis.

check HCV RNA at 3 weeks and 3/12 post exposure, if + refer.

risk of transmission 2% if infected pt from needlestick

47
Q

HepB needlestick protocol

A

all depends on vax status of person who got poked, if 3 imms and anti-HepB > 10, then do nothing, if < 10 depends on their prev vax history and risk of the particular exposure, vaccine and HBIG are options.

48
Q

HIV needlestick protocol

A

risk of infection 0.1% from needlestick

if low risk exposure: test for HIV at 3/52, 6/52 and 6 months

if high risk exposure: start PEP and f/u public health (often 5 day starter pack). PEP shoudl be started within 72 hrs, ideally within 2 hrs.

49
Q

malarian transmission and organisms

A

plasmodium (a protzoa) is transmitted by mosquito bites.

50
Q

clinical manisfestations of malaria

A

generally causes hemolytic anemia, symptoms are nonspecific, usually fever/malaise, sometimes jaundice. often fevers come in waves as RBC lyse in cycles

51
Q

diagnosis of malaria

A

thick and thin blood smears looking for parasites X3 q 24 hrs to r/o

if +, send for speciation

52
Q

malaria endemic areas

A

central america, carribean, south america, south asia, africa

53
Q

treatment of malaria?

A

depends on species, area and sensitivies. choloroquine is classic tx but there is some resistance issues

54
Q

ebola, signs/symptoms, when to consider and mgmt

A

fever/HA/GI/rash/eays brusing
recent travel to africa (esp West and central)
tx is supportive and isolation (spread via bodily fluids)

55
Q

Dengue, virus, signs/symptoms, when to consider and mgmt

A

-flavivirus
-fever, n/v, bone pain.
(can cause hemmorhagic fever too)
-spread by moquitos anywhere tropical (including florida)
-tx is supportive (fluids, pain mgmt)

56
Q

leptospirosis: organism, signs/symptoms, when to consider and mgmt

A

causes by leptospirosis interrogans (obligate anaerobe, gram neg spirochete)

causes biphasic dz: firts febrile illness, then Wil syndome (multi organ failure: icterus, renal failure, ARDS).

suspect when exposure ot contaminated freshwater (percutaneous or mucus membranes) in tropical areas.

tx is doxy and amox

57
Q

chagas disease: organism/distribution, symptoms, dx and treatment

A

parasite T cruzi passed on by bugs in tropical areas including Southern US,
can cause myocarditis/heart failure, symptoms of fever and malaise. dx is blood smear and tx Nifurtimox

58
Q

test for acute HIV?

A

send HIV viral load, HIV ab test will be neg for 3-12 weeks

59
Q

RF for HIV (4)

A

MSM
IVDU
unprotected intercourse
blood transfusion before 1985

60
Q

what CD4 count does AIDS happen, when can you start to get symtpoms/

A

AIDS <200,

early symptomatic <500

61
Q

3 AIDS defining pulm infections

A

histoplasmosis
coccidiomycosis
pneumocystis pneumonia (PCP)

62
Q

histoplasmosis

A
63
Q

coccidiomycosis

A
64
Q

pneumocystis pneumonia (PCP)

A
65
Q

systems HIV can present with/involve

A

pulm, CNS, GI, dermatologic, opthalmologic

66
Q

do you need CT before LP in HIV

A

YES

67
Q

multidermatomal VZV (shingles) is suspicious for?

A

HIV

68
Q

Disease in HIV based on CD4

A
69
Q

dx of AIDS

A

cd4 <200 or HIV with AIDS defining illness (lots of them)

70
Q
A
71
Q

Hairy leukoplakia vs thrush

A

Thrush comes off easier. Leukoplakia is more lateral on tongue

72
Q

Can cd4 count improve with anti retrovirals? Can aids be reversed?

A

Yes and yes

73
Q

Rabies organism

A

Lyssavirus

74
Q

indication and dose for lyme prophylaxis

A

ixodes bite, attached >36hrs, doxy 200 mg single dose

75
Q

stages of lyme

A

early localized: erythema migrains, flulike symptoms

early disseminated: arthitis, disseminated erythema migrans, neuro sx, AVB

late disseminated: neuropathy, encephalopathy, chronic arthritis

76
Q

RMSF organism

A

ricketsia rickettsii

77
Q

RMSF spread

A

tick bites, mostly in appalachia

78
Q

RMSF triad

A

tick expsoure, fever, rash (can be petechial/pupuric, starts distally (palms and soles) and moves centrally)

79
Q

treatment for RMSF

A

treat empirically with doxycycline (25% mortality if not treated)

80
Q

other tick spread illnesses (4)

A

babesiosis, ehrlichiosis, q fever, colorado tick fever

81
Q
A
82
Q

Diphtheria:say a bit about it

A

CCFP EM (20 decks)

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