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Medicine Clerkship > Learning Objectives - Infectious Disease > Flashcards

Learning Objectives - Infectious Disease Flashcards

1
Q

Bacteriostatic vs. bacteriocidal?

A

Static - stops bacteria from reproducing

Cidal - kills bacteria

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2
Q

Minimum inhibitory concentration (MIC)?

A

Lowest concentration of a chemical that prevents visible growth of a bacteria

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3
Q

Minimum bactericidal concentration?

A

Lowest concentration that results in microbial death

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4
Q

List the 7 major classes of antibiotics.

A
  1. Pencillins
  2. Cephalosporins
  3. FQs
  4. AGs
  5. Monobactams
  6. Carbapenems
  7. Macrolides
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5
Q

List the penicillins.

A

Natural: G, VK
Pencillinase-resistant: methicillin, nafcillin, oxacillin
Aminopenicillin: ampicillin

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6
Q

List the 4 first generation cephalosporins.

A
  1. Cephalothin
  2. Cefazolin (Ancef/Kefzol)
  3. Cephapirin
  4. Cephalexin (Keflex)
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7
Q

List the 2 second generation cephalosporins.

A
  1. Cefacor

2. Cefotetan

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8
Q

List the 1 third generation cephalosporin.

A
  1. Ceftriaxone
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9
Q

List the 2 fourth generation cephalosporins.

A
  1. Cefpirome

2. Cefepime

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10
Q

List the 4 FQs.

A
  1. Ciprofloxacin
  2. Levofloxacin
  3. Moxifloxacin
  4. Norfloxacin
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11
Q

List the 5 AGs.

A
  1. Amikacin
  2. Gentamicin
  3. Kanamycin
  4. Neomycin
  5. Tobramycin
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12
Q

List the 1 monobactam.

A
  1. Aztreonam
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13
Q

List the 3 carbapenems.

A
  1. Ertapenem
  2. Imipenem
  3. Meropenem
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14
Q

List the 5 macrolides.

A
  1. Azithromycin
  2. Clarithromycin
  3. Erythromycin
  4. Clindamycin
  5. Dirithromycin
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15
Q

List the 5 other major ABX.

A
  1. Vancomycin
  2. Rifampin
  3. Doxy/tetracycline
  4. Linezolid
  5. TMP-SMX
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16
Q

What organisms are commonly associated with HEENT infections (pharyngitis, acute bronchitis, acute sinusitis, chronic sinusitis)?

A

Pharyngitis: viral, GAS
Acute bronchitis: viral
Acute sinusitis: viral, S. Pneumo, H. influenzae, M. catarrhalis
Chronic sinusitis: S. aureus, anaerobes

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17
Q

What organisms are commonly associated with Lung infections (CAP, atypical CAP, HAP, aspiration pneumonia)?

A

CAP: S. pneumo (60%), H. influenzae (15%), M. cattarhalis (same as acute sinusitis)
Atypical: mycoplasma, Chlamydia pneumoniae/psittaci, Legionella, influenza, adenovirus, parainfluenza virus, RSV
HAP: E. coli, pseudomonas, S. aureus
Aspiration: oral anaerobes, GN rods, S. aureus

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18
Q

What organisms are commonly associated with Cardiac infection (subacute endocarditis, acute endocarditis)?

A

Subacute: S. viridans (other GP)
Acute + IVDU: S. aureus, GN rods, enterococcus, yeast
Prosthetic: S. epidermidis

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19
Q

What organism are commonly associated with Abdominal infections (gastroenteritis, intra-abdominal)?

A

Gastroenteritis: viral, Salmonella, Shigella, E. coli, Clostridium botulinum, Giardia, Helicobacter, Campylobacter

Intra: enterococcus, B. fragilis, E. coli

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20
Q

What organisms are commonly associated with Skin infections?

A

S. aureus, GAS (pyogenes), C. perfringens, candidiasis

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21
Q

What organisms are commonly associated with Bone infections?

A 
S. aureus
Coag-negative Staph
Gonococcal arthritis (young adults)
Salmonella
Pseudomonas (sickle cell)
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22
Q

What organism are commonly associated with GU infections?

A 
E. coli (80%)
S. saprophyticus
Enterococcus
Klebsiella
Proteus
Pseudomonas
Enterobacter
Yeast (candida)
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23
Q

List 3 reasons why a particular antibiotic regiment may fail.

A
  1. Incomplete coverage of the infection
  2. Resistance
  3. Non-compliance
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24
Q

List 16 infectious diseases that are potentially life-threatening.

A
  1. Diphtheria
  2. Hepatitis B and C
  3. HIV
  4. TB
  5. Viral hemorrhagic fevers
  6. Meningococcal disease
  7. Plague (Y. pestis)
  8. Rabies
  9. Anthrax
  10. Influenza
  11. MMR
  12. Pertussis
  13. SARS-CoV
  14. Smallpox
  15. Vaccinia
  16. Varicella
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25
Q

List 6 general clinical risk factors for nosocomial infection.

A
  1. Immunocompromise
  2. Immunosuppressive drugs
  3. Extremes of age
  4. Compromise of skin/mucosal surfaces secondary to:
    - Drugs
    - Irradiation
    - Trauma
    - Invasive procedures
    - Invasive indwelling devices
  5. Broad-spectrum ABX
  6. Immobilization
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26
Q

Risk factors for UTI?

A 
Females
Sexual intercourse
Pregnancy
Indwelling urinary catheters
Hx of UTIs
DM
Spinal cord injury
Immunocompromised
Structural/functional abnormality
Foreskin
Anal intercourse
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27
Q

Clinical features of UTI?

A

Dysuria, frequency, urgency, suprapubic tenderness, gross hematuria

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28
Q

Presentation of typical CAP?

A

Acute onset fever, shaking chills, cough productive of thick, purulent sputum, pleuritic chest pain, dyspnea

Tachycardia, tachypnea, late inspiratory crackles, bronchial breath sounds, increased tactile and vocal fremitus, dullness on percussion, pleural friction rub

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29
Q

Presentation of atypical CAP?

A

Insidious onset, headache, sore throat, fatigue, myalgias, dry cough, fevers

Pulse/temperature dissociation (normal pulse with high fever), wheezing/rhonchi/crackles

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30
Q

Compare CXR of typical vs. atypical CAP.

A

Typical: lobar consolidation
Atypical: diffuse reticulonodular infiltrates

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31
Q

Most common organisms causing intravascular device-related bacteremias?

A

S. aureus, S. epidermidis

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32
Q

Most common organisms causing cellulitis?

A

GAS, S. aureus

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33
Q

Presentation of cellulitis?

A

Inflammatory condition of the skin and subcutaneous tissue with erythema, warmth, pain, swelling, fever

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34
Q

Most common cause of erysipelas?

A

GAS

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35
Q

Presentation of erysipelas?

A

Well-demarcated fiery red painful lesion, high fever, chills; confined to the dermis and lymphatics

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36
Q

Common causes of necrotizing fasciitis?

A

GAS, C. perfringens

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37
Q

Which has a higher risk of infection - PICC or central line?

A

Central line

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38
Q

Common causes of central-line associated bloodstream infections?

A

Coag-negative staph, S. aureus, candida, enterococcus

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39
Q

When are empiric antibiotics indicated in a possible hospital-acquired infection?

A

Unstable patient
Sepsis
Neutropenia
Significant immunocompromise

40
Q

List the top 8 pathogens for hospital-acquired infections.

A
  1. S. aureus
  2. Enterococcus
  3. E. coli
  4. Coag-negative staph
  5. Candida
  6. K. pneumonia/oxytoca
  7. P. aeruginosa
  8. Enterobacter
41
Q

Empiric therapy for central line associated bloodstream infection (CLABSI)?

A

Vancomycin (also remove the line)

42
Q

Empiric therapy for CAUTI?

A

Ceftriaxone 1 g IV

If pseudomonas is suspected, use Ceftazidime

43
Q

Empiric therapy for pneumonia (VAP, HAP, HCAP)?

A

Levofloxacin

Other reasonable options include ceftriaxone, unasyn, and ertapenem

If concern for resistant GN rods, use Zosyn (pip/tazo)

44
Q

Empiric treatment for C. difficile infection?

A

Oral metronidazole or oral vancomycin

45
Q

Prophylactic treatment for surgical site infection?

A

Cefazolin

46
Q

SIRS?

A

2+ of the following:

RR>20
HR>90
T>38 C or <36 C
WBC >12K, <4K, or if >10% bandemia

47
Q

Sepsis?

A

SIRS + suspected source of infection

48
Q

Which types of shock have cool extremities?

A

Cardiogenic

Hypovolemic

49
Q

Which types of shock have warm extremities?

A

Septic shock

50
Q

Septic shock?

A

Sepsis
Persistent hypotension requiring vasopressors to maintain a MAP of 65+
Serum lactate >2 mmol/L (18 mg/dL)
All despite adequate volume resuscitation

51
Q

qSOFA?

A

GCS <15 (AMS)
Systolic BP <100
RR 22+

52
Q

Which type of shock presents with bradycardia rather than tachycardia?

A

Neurogenic shock (associated with severe SC/CNS injury)

53
Q

Best immediate treatment for sepsis?

A

Fluid challenge/bolus (typically 10-30 cc/kg) or NS or LR over 30 minutes

54
Q

Empiric treatment for patients with life-threatening sepsis?

A

IV Vancomycin + Zosyn + Aztreonam

55
Q

True or false - gram positive organisms account for most cases of sepsis, but gram negatives are responsible for the majority of UTI_associated sepsis.

A

True

56
Q

Most likely causes of community-acquired UTI-associated sepsis?

A

E. coli, Klebsiella, Proteus (nitrite + on UA)

57
Q

Empiric antibiotic treatment of community-acquired UTI-associated sepsis?

A

TMP-SMX

If community resistacne exceeds 10%, treat with a FQ.

Ampicillin may still be effective, but high resistance rates preclude treatment as empiric first-line therapy.

3rd and 4th generation cephalosporins are also good choices (broad GN and partial GP coverage)

Consider AG if Pseudomonas is possible

58
Q

In general, what are empiric antibiotics indicated for a suspected GN negative source?

A 
Third- or fourth-generation cephalosporin
Pip/tazo
Ticarcillin/clavulanate
Imipenem/meropenem
Aztreonam

Add AG if immunocompromised

59
Q

Normal opening pressure range (CSF)?

A

60-200 mmH2O

60
Q

CSF opening pressure above ___ mm H2O are diagnostic of what?

A

250; intracranial hypertension

61
Q

Normal CSF color?

A

Crystal clear

62
Q

Orange CSF?

A

Rifampin

63
Q

What is xanthochromia and what does it indicate?

A

Orange-brown discoloration of the CSF resulting from the presence of Hgb breakdown products

In a patient WIHTOUT jaundice, this raises suspicion of occult intracranial hemorrhage (subarachnoid)

64
Q

Presence of RBCs in CSF?

A
  • Intracranial hemorrhage

- Nicking of a dural blood vessel when advancing the needle

65
Q

How can a traumatic tap be ruled out?

A

CSF fails to clear (if traumatic tap, the CSF should become progressively clearer and tests for xanthochromia should be negative)

66
Q

Presence of WBCs in CSF?

A

Monocytes are normal WBCs in the CSF, should only be present in low numbers

> 5 WBCs/mL is abnormal, as is the presence of neutrophils (suggest bacterial infection)

67
Q

Typical ratio used to determine the # of WBCs that can be accounted for by a traumatic tap is?

A

1 WBC for each 500 RBCs

68
Q

Increased protein in the CSF?

A

Found when cells are dying and decaying (intracerebral bleed, demylination, tumor invasion, infection)

NON-SPECIFIC FINDING

69
Q

Typical ratio used to determine the amount of protein accounted for by a traumatic tap?

A

1 g/dL protein for each 1,000 RBCs

70
Q

CSF glucose?

A

When infection or inflammation disrupt the activity of glucose transport pumps, CSF glucose declines below normal levels

Hypoglycorrhachia - depression of CSF glucose below 40% of the simultaneous serum value

71
Q

GP diplococci in CSF?

A

S. pneumonia

72
Q

GP bacilli in CSF?

A

L. monocytogenes

73
Q

GN diplococci in CSF?

A

N. meningitidis

74
Q

GN bacilli in CSF?

A

E. coli or Pseudomonas

75
Q

GN coccobacilli in CSF?

A

H. influenzae

76
Q

Compare opening pressure in bacterial vs. viral vs. fungal vs. tubercular meningitis.

A

B - elevated
V - usually normal
F - variable
T - variable

77
Q

Compare WBC count in bacterial vs. viral vs. fungal vs. tubercular meningitis.

A

B - 1000+ per mm^3
V - <100/mm^3
F - variable
T - variable

78
Q

Compare cell differential in bacterial vs. viral vs. fungal vs. tubercular meningitis.

A

B - PMN predominance

V/F/T - Lymphocyte predominance

79
Q

Compare protein levels in bacterial vs. viral vs. fungal vs. tubercular meningitis.

A

B - mild to marked elevation
V - normal to elevated
F/T - elevated

80
Q

Compare CSF:Serum glucose ratio in bacterial vs. viral vs. fungal vs. tubercular meningitis.

A

B - normal to marked decrease
V - usually normal
F/T - low

81
Q

When is contact isolation indicated?

A

Infections spread by fecal-oral route or skin colonization

82
Q

When is droplet isolation indicated?

A

Pathogens spread through close respiratory or mucous membrane contact with respiratory secretions

Does NOT require special air handling/ventilation; wear a mask

Pertussis, N. meningitidis, GAS
Influenza, adenovirus, rhinovirus

83
Q

When is airborne isolation indicated?

A

Pathogens that remain infectious over long distances when suspended in the air

Smallpox, measles, varicella, TB, SARS/MERS

84
Q

What is Brudzinski’s sign?

A

Increased pain and involuntary flexion of the legs at the hip and knee with passive neck flexion

85
Q

What is Kernig’s sign?

A

Increased neck pain and resistance to extension of the knee when the hip is flexed at 90 degrees

86
Q

DDx - Vomiting + Photophobia + Headache without Localizing Neurologic Deficits

A
  1. Bacterial/viral meningitis
  2. Subarachnoid hemorrhage
  3. Migraine

Less likely:

  1. CVA
  2. Cerebral vasculitis
  3. Intracerebral abscess
  4. Temporal arteritis
  5. Tension and cluster headache
  6. Toxo
  7. Primary CNS lymphoma
87
Q

Presentation of meningitis?

A

Acute onset of headache after a prodromal illness, associated fever, photophobia, N/V, meningismus

88
Q

Presentation of subarachnoid hemorrhage?

A

“Worst headache of my life”
Vomiting
[Meningeal signs/fever/photophobia may be present, but uncommon]

89
Q

Empiric treatment of suspected bacterial meningitis?

A

ABX within 1 hour: empiric vancomycin + third-generation cephalosporin; add ampicillin if 50+, hx alcohol abuse, and/or immunocompromise
Corticosteroids (dexamethasone): significant protection against death and neurologic sequelae (subgroup analysis shows this benefit only exists when S. pneumonia was the cause)

90
Q

Indications for head imaging prior to LP to evaluate for brain shift and herniation risk?

A

Clinical signs of increased ICP/cerebral edema, patients with confusion, decreased level of consciousness, focal neuro abnormalities, associated head trauma, recent seizures

Historical risk factors: immunosuppressed patients, history of stroke, history of space-occupying lesion

91
Q

Indications for urgent LP?

A

Bacterial meningitis

Subarachnoid hemorrhage

92
Q

Common causes of bacterial meningitis?

A

Adults: N. meningitidis, S. pneumonia
>50: also L. monocytogenes and aerobic GN bacilli
Alcohol abuse/immunocompromise: H. influenzae

93
Q

Treatment of endocarditis?

A

Empiric treatment: vancomycin or Unasyn + AG +rifampin IF prosthetic valves

If non-hemolytic strep (likely enterococcus): uniformly resistant to penicillin, treat with ampicillin, AG, or vancomycin

Beta-lactams + AG -> bacteriocidal synergy

94
Q

Rx cellulitis?

A

Without an ulcer - coverage for staph and strep is reasonable (oral/parenteral beta-lactams, 1st gen cephalosporin, clinda)

If complicated/contaminated infection - broad-spectrum to cover anaerobes, pseudomonas, bacteroides

95
Q

Rx HSV meningitis?

A

Acyclovir

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