infectious Dz p 13 -22 Flashcards
how would you treat thousands of neutrophils in CSF?
ceftriaxone, vancomycin, and steroids
a pt suspected to have a bacterial meningitis but CSF result came out for negative for glucose and protein, would you still treat?
depends, if you see elevated white count in CSF, yes treat.
most accurate diagnostic test for TB?
acid fast and culture on 3 high volume lumbar punctures
what are the risk factors (six) for Listeria?
elderly, neonates, steroid use, AIDS/HIV, immunocompromised, including alcoholism, pregnant
choice of antibiotics for Listeria?
ampicillin (Listeria is resistant to all cephalosporin)
what do you mean by “close contact?”
household contacts, kissing, sharing cigarettes or eating utensils (routine school/work contact is not close contact)
most common neurological deficit of untreated bacterial meningitis?
8th cranial nerve deficit or deafness
best initial therapy for herpes encephalitis?
acyclovir
limitations for famciclovir and valacyclovir?
not available as IV formulation
a pt with herpes encephalitis was given acyclovir with no improvement, what is the best next step?
give foscarnet
what is the most specific test for cryptococcus?
culture of the fungus
explain the sensitivity and specificity of latex agglutination test
highly specific if you get positive result, but has low sensitivity, if negative, can not rule out the infection
how do you diagnose viral meningitis?
dx of exclusion
a pt comes with an acute fever, confusion. you suspect encephalitis, what is the most likely dx? what is your next best step?
herpes simplex, head CT
a pt at a medicine floor has been treated with acyclovir for days, what side effect should you be worried about?
renal toxicity ,b/c acyclovir precipitates in the renal tubule
what is the most sensitive physical finding for otitis media?
immobility
what is the most accurate dx test for otitis media?
tympanocentesis for a sample of fluid for culture
what is the best initial therapy for otitis media?
amoxicillin
what type of antibiotic is contraindicated to child?
quinolones (cartilage damage)
5 y/o kid with otitis media came back with no respond to the amoxicillin you gave a week ago, what is your next step?
give below antibiotics
- amoxicillin/clavulanate
- azithromycin, clarithromycin
- cefuroxime, loracarbef
- levofloxacin, gemifloxacin, moxifloxacin
5 y/o kid with multiple recurrences of otitis media did not respond to multiple antibiotics, what is your next step?
tympanocentesis
what are the 2 indications for a biopsy in sinusitis?
- frequent infection
2. no response to different empiric therapies
pt comes in with sx of pain on swallowing, enlarged lymph node, exudate in the pharynx fever most likely dx? why is it important to treat this pt?
strep pharyngitis, prevent rheumatic fever
best initial therapy for strep pharyngitis?
penicillin or amoxicillin
pt is allergic to penicillin, what is your alternatives?
if the rxn is only rash, use cephalexin, if the rxn is anaphylaxis, use clindamycin or macrolide
a pt with pharyngitis is likely to have cough or hoarseness?
No
a 30 y/o healthy male comes in with joint pain, cough, fever, headache/sore throat, nausea, vomiting, what is most appropriate next step in management?
depends on time,
if within 48 hrs since the onset of symptoms –> perform a nasopharyngeal swab/wash to rapidly detect the antigen and give oseltamivir, zanamivir
more than 48 hrs, symptomatic treatment only
a pt who has hemochromatosis and frequent blood transfusion comes in with blood and white cells in stool, what is the likely causing agent?
Yersinia
a 20 y/o male comes in with symptoms of bloody diarrhea who has been healthy. Blood work shows anemia, low platelet counts, and creatinine level of 2, you did some work-up and confirmed that E. coli is not the causing agent, what is the most likely causing this?
Shigella
a 40 y/o female who had sushi last night comes in with sudden onset of wheezing, flushing, and rash, what is the dx? and how would you treat?
scombroid, treat with antihistamine
which type of hepatitis is known to rarely present with an acute infection?
hepatitis C
which 2 types of hepatitis are spread through food or water?
A and E
You Ate hepatitis A
You Eat hepatitis E
name 9 symptoms of acute hepatitis
jaundice, fever, weight loss, fatigue, dark urine, hepatosplenomegaly, nausea, vomiting, abdominal pain
name 3 diagnostic tests for acute hepatitis
- inc direct bilirubin
- inc ratio of ALT to AST
- inc alkaline phsophatase
what is the best initial diagnostic test for hepatitis?
IgM antibody for acute infection and IgG antibody for resolution of infection
best test to assess disease activity of hep C
PCR for RNA level
Dx?
surface antigen +
e-antigen +
core antibody + for IgM or IgG
surface antibody -
acute or chronic infection
Dx?
surface antigen -
e-antigen -
core antibody + for IgM then IgG
surface antibody -
window period
Dx?
surface antigen -
e-antigen -
core antibody + for IgG
surface antibody +
resovled, old, past infection
what is the measure of actual viral partical?
surface antigen
the presence of E-antigen indicates
high level of DNA polymerase activity
True or false?
PCR viral measure the DNA of hep B is the best initial diagnostic test
false
what are the 2 most important parameters to assess the degree of infectivity?
hepatitis DNA viral load, e-antigen
best treatment for hep A and E?
none, they resolve spontaneoulsy
what is the % of acute hep B to become chronic?
10%
True of false
Only acute hep C gets medical therapy
true
name 4 drugs for acute hep C
interferon, ribavirin, boceprevir, telaprevir
side effects of interferon?
arthralgia, myalgia, leukopenia, thrombocytopenia, depression, flu-like symptoms
2 goals of chronic hepatitis therapy
- reduce DNA polymerase to undetectable levels
2. convert those pts with e-antigen to having anti-hepatitis e-antibody
True of false
interferon is rarely used first line in hepatitis
True due to side effects
