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Clin Med - ID > Lecture 3 - Cases > Flashcards

Lecture 3 - Cases Flashcards

1
Q

What causes pharyngitis and how do we treat it?

A

MC viral
Group A, C, H strep

Treat Group A strep (d/t risk of sequelae: scarlet fever, rhuematic fever)
PCN V x 10 days (or Amoxicillin if kids)
PCN allergy? Clinda or azithromycin

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2
Q

What is the treatment for group a strep in a young child?

A

Amoxicillin (PCN for everyone else, or clinda or azithro if PCN allergy)

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3
Q

What is the treatment for group a strep pharyngitis for those with a PCN allergy?

A

Clindamycin or azithromycin

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4
Q

What causes a UTI and how do we treat it?

A

Gram negative rods, enterococcus, staph, chlyamydia

Tx: nitrofurantoin
Bactrim or Quinolones (not in pregnancy)
Ceftriaxone PO

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5
Q

What causes OM and how do we treat it?

A

Viral: rhino, RSV, corona
Bacterial: strep pneumo, H. Flu, M. Cat

Tx: amoxicillin (<2yo always, older than 2 depends on some stuff)

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6
Q

What causes CAP and how do we treat it?

A 
Virus 
S. Pneumo (MC) 
Mycoplasma (MC atypical walking PNA) 
Chlamydia
H. Flu 
M. Cat 
Gram negative rods

For a healthy young adult the MC are: viral, mycoplasma chlamydia

Tx: macrolides (azithromycin - covers atypicals)

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7
Q

What causes meningitis and how do we treat it?

A 
Viruses
S. Peumo 
Neisseria m. 
H. Flu
Listeria (immunocompromised) 
Fungal: cryptococcus neofromans

CSF (Bacterial): low glucose, high protein

Tx: ceftraixone + vacno IV (+ ampicillin if listeria)

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8
Q

What is the MC cause of hospital acquired PNA and how do we treat it?

A

Staph aureus

Tx: cefepime + vanco

Cefepime (4th generation cephelosporin that covers MSSA and psuedomonas)

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9
Q

What is the tx for a post op wound infection?

A

Staph, strep, enterococcus

Tx: augmentin
Vanco is MRSA

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10
Q

When is PO vanco an appropriate treatment?

A

C. Diff only

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11
Q

What is the treatment for chlamydia and gonorrhea?

A

Chalmydia: 1 gram azithromycin (or doxy)

Gonorrhea: 250mg ceftriaxone + azithromycin

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12
Q

What is the treatment for chancroid? Syphilis?

A

Chancroid: ceftriazone (or azithromycin)

Syphilis: PCN G IM

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13
Q

What is the treatment for giardia?

A

Metronidazole

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14
Q

What are the different causes of acute vs chronic sinusitis and how do we treat?

A 
Acute Sinusitis: (same as OM)  
Viruses 
S. Penumo
H. Flu 
M. Cat

Tx: augmentin (+/- saline irrigation)
IF: sxs >/= 10 days, severe sxs for >3 days, or worse sxs post URI

Chronic:
Staph
Anaerobes
Fungal

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15
Q

What causes bronchitis and whats the treatment?

A

Viral MC

The longer the sxs the more likely its bacterial

Chlaymdia PNA, mycoplasm PNA, bordetella pertussis

Tx:
Antitussive
Inhaled bronchodilator

Doxycycline (if bacterial)

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16
Q

Whats the workup for a DM foot ulcer and how do we treat?

A

CBC, glucose, CMP, wound culture, Xray (r/o osteomyelitis)

Tx:
Anerobes: IV metronidazole or clindamycin
B. Fragillis: zosyn or unasyn

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17
Q

What are the GI parasties?

A

Giardia (beaver fever)
Amoebiasis (cysts, Entamoeba Histolytica, outside US)
Cryptosporidosis (modified acid fast)

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18
Q

What are the tissue parasites?

A 
Trypanosmiasis Cruzi (chagas - kissing bug - infection last YEARS) 
Trypanosmiasis Brucei (HAT - tsetse fly - G months - years) 
Leishmaniasis (sandfly - black fever - intracellular)
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19
Q

What are the blood parasites?

A 
Plasmodium 
Babesia (ixodes ticks - intraerythrocytic - ARDS complications - maltese cross)
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20
Q

What is the medication regimen for PrEP?

A

Tenofovir DF + emtracitabine PO daily

F/u q3 months for renal function tests

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21
Q

Owls Eye

A

Seen with CMV retinitis CD4 <50

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22
Q

Ring enhancing lesions

A

Seen on CT/MRI with toxoplasma gondii

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23
Q

What prophylaxis should be started at CD4 <75-50?

A

MAC with azithromycin 1200mg weekly

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24
Q

What is the drug regimen for PEP?

A

Raletgravir + tenofovir DF + emtracitabine

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25
Q

Statins shouldnt be taken with which HIV drugs?

A

Protease inhibitors

26
Q

Kaposis sarcoma

A

HSV 8

27
Q

India Ink Stain

A

Crypotococcus neoformans
Encapsulated fungus
Chronic meningitis in HIV
Lung infections

28
Q

Who gets tuberculosis prophylaxis?

A

+ PPD
Or anyone with contacts who have TB

Isoniazid + B6

29
Q

Polyradiuclopathy: ascending weakness —> flaccid paralysis

A

CMV

CSF CMV PCR

Tx: ganciclovir

30
Q

Hemiparisis, cognitive impairment

A

PML - progressive multifocal leukoencephalopathy

JC virus

CNS infection

Dx: LP JC virus PCR

31
Q

Toxoplasmosis is seen at what CD4 level?

A

CD4 < 100

CNS occupying lesion seen as ring or contrast enhancing on CT/MRI

32
Q

What are the pap smear guidelines for HIV pts?

A

Twice in the 1st year of dx

Annually after that if no change in sxs

33
Q

What is the most common cause of chronic diarrhea in HIV and how is it dx?

A

Cryptosporidum parvum

Watery diarrhea

Dx: modified acid fast

Pretty sure this can lead to wasting (>10% loss of body mass)

34
Q

How do you treat plasmodia ovale?

A

FIRST test for G6PD deficiency

If no deficiency then start primaquine to kill the dormant parasites in the liver

Then give chloroquine to treat the acute infection

35
Q

How do p. Ovale and p. Vivax differ?

A

Both can lay dormant in the liver

Vivax can cause splenic rupture
Vivax needs duffy antigen to enter cells

36
Q

Kopliks spot

A

Mouth sore seen with measles

In addition to fever + URI

Rash migrates from face toward the rest of the body

Prevention: MMR (live) vaccine
CI: pregnancy, egg allergy

37
Q

Besides everybody over the age of 65, who else gets the pneumococcal vaccine?

A 
Chronic heart, lung, liver dx 
EtOHism, smokers
DM 
Immunodeficiency
HIV
Asplenia
38
Q

If a pt who just got a prosthetic heart valve 30 days ago presents with fever, anemia, a new heart murmur, and a spot of her sole, what should you be thinking?

A

Endocarditis

If <60 days since surgery MC cause is staph
If >60 days since surgery MC cause is strep

39
Q

What is the treatment for acute endocarditis?

A

Nafcillin + gentamicin x 4-6 weeks

+/- surgery:

  • CHF
  • systemic embolization
  • uncontrolled sepsis
  • myocardia abscess
  • fungal infection
  • +/- large vegitation
40
Q

What is the treatment for subacute endocarditis?

A

PCN + gentamicin

41
Q

Who gets tested for HIV?

A

Everyone at least once between 15-64yo
At risk populations
Every pregnant pts

42
Q

What classes of drugs are considered first line for HIV?

A

2 NRTIs + 1 integrase inhibitor

43
Q

With which HIV drugs MUST you add a booster to?

A

Protesase inhibitors

44
Q

What viral load is considered undetectable?

A

<20 cells

Undetectable = untransmittable

45
Q

You are awaiting HLAb5701 and HBV testing for a pt recently dx with HIV, what drugs should you star them on?

A

Dolutegravir + tenofovir/emtrictabine

46
Q

When is the best time to start PEP?

A

Within 2 - 72 hours

47
Q

You started a pt on PrEP, what do you tell the pt in regards to when they can start to have safe sex without worrying about HIV?

A

Women need to wait 3 weeks before meds are effective

Men need to wait 1 week before meds are effective

48
Q

When do you see a blanchable macuplopapular rash in HIV pts?

A

During 2-4 weeks after initial infection

Primary infection

49
Q

Diffuse intersitial infiltrates are seen with which pulmonary sequelae in HIV?

A

Pneumocysitis jiovecii

50
Q

Severe decline in clinical status after ART initiation d/t inflammation response against infection (despite improved immune function)

A

IRIS

51
Q

Which antibiotics inhibit protein synthesis?

A

MAT (50S, 30S, 30S)

Macrolides
Aminoglycosides
Tetracyclines

52
Q

What antibiotics kill MSSA?

A

DON

Dicloxacillin
Oxacillin
Nafcillin

methicillin isn’t used anymore

53
Q

What antibiotic can be used for VRE?

A

Daptomycin

Doesn’t work in lungs

54
Q

What is the incubation of malaria?

A

1 week

55
Q

ACTs

A

Artemisin based comibination therapies for p. Falciparum

56
Q

When do you treat FUO with abx?

A

ONLY if they also have neutropenia

57
Q

When dx endocarditis, is TTE or TEE more sensitive?

A

TEE

Transesophageal echo (vs transthroacic)

58
Q

What is the prophylaxis used for endocarditis pt?

A

Amoxicillin or cephalexin 2g PO

59
Q

RIPE

A

Rifampin + INH + PZA + ethambutol

For initial phase of TB

Also give B6 (pyridoxine)

60
Q

Rickettsia ricketssi

A

RMSF

Triad: HA, fever, rash

Rash starts on palms and sole and spreads centrally over 2-3 days

2-14 days after sxs being = onset

61
Q

Borrelia burgdorferi

A

Lyme disease

Same tick that causes babesiosis

Dx: ELISA + western blot

Clin Med - ID (9 decks)

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