Lecture 3 - Cases Flashcards
What causes pharyngitis and how do we treat it?
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
What is the treatment for group a strep in a young child?
Amoxicillin (PCN for everyone else, or clinda or azithro if PCN allergy)
What is the treatment for group a strep pharyngitis for those with a PCN allergy?
Clindamycin or azithromycin
What causes a UTI and how do we treat it?
Gram negative rods, enterococcus, staph, chlyamydia
Tx: nitrofurantoin
Bactrim or Quinolones (not in pregnancy)
Ceftriaxone PO
What causes OM and how do we treat it?
Viral: rhino, RSV, corona
Bacterial: strep pneumo, H. Flu, M. Cat
Tx: amoxicillin (<2yo always, older than 2 depends on some stuff)
What causes CAP and how do we treat it?
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)
What causes meningitis and how do we treat it?
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)
What is the MC cause of hospital acquired PNA and how do we treat it?
Staph aureus
Tx: cefepime + vanco
Cefepime (4th generation cephelosporin that covers MSSA and psuedomonas)
What is the tx for a post op wound infection?
Staph, strep, enterococcus
Tx: augmentin
Vanco is MRSA
When is PO vanco an appropriate treatment?
C. Diff only
What is the treatment for chlamydia and gonorrhea?
Chalmydia: 1 gram azithromycin (or doxy)
Gonorrhea: 250mg ceftriaxone + azithromycin
What is the treatment for chancroid? Syphilis?
Chancroid: ceftriazone (or azithromycin)
Syphilis: PCN G IM
What is the treatment for giardia?
Metronidazole
What are the different causes of acute vs chronic sinusitis and how do we treat?
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
What causes bronchitis and whats the treatment?
Viral MC
The longer the sxs the more likely its bacterial
Chlaymdia PNA, mycoplasm PNA, bordetella pertussis
Tx:
Antitussive
Inhaled bronchodilator
Doxycycline (if bacterial)
Whats the workup for a DM foot ulcer and how do we treat?
CBC, glucose, CMP, wound culture, Xray (r/o osteomyelitis)
Tx:
Anerobes: IV metronidazole or clindamycin
B. Fragillis: zosyn or unasyn
What are the GI parasties?
Giardia (beaver fever)
Amoebiasis (cysts, Entamoeba Histolytica, outside US)
Cryptosporidosis (modified acid fast)
What are the tissue parasites?
Trypanosmiasis Cruzi (chagas - kissing bug - infection last YEARS) Trypanosmiasis Brucei (HAT - tsetse fly - G months - years) Leishmaniasis (sandfly - black fever - intracellular)
What are the blood parasites?
Plasmodium Babesia (ixodes ticks - intraerythrocytic - ARDS complications - maltese cross)
What is the medication regimen for PrEP?
Tenofovir DF + emtracitabine PO daily
F/u q3 months for renal function tests
Owls Eye
Seen with CMV retinitis CD4 <50
Ring enhancing lesions
Seen on CT/MRI with toxoplasma gondii
What prophylaxis should be started at CD4 <75-50?
MAC with azithromycin 1200mg weekly
What is the drug regimen for PEP?
Raletgravir + tenofovir DF + emtracitabine
Statins shouldnt be taken with which HIV drugs?
Protease inhibitors
Kaposis sarcoma
HSV 8
India Ink Stain
Crypotococcus neoformans
Encapsulated fungus
Chronic meningitis in HIV
Lung infections
Who gets tuberculosis prophylaxis?
+ PPD
Or anyone with contacts who have TB
Isoniazid + B6
Polyradiuclopathy: ascending weakness —> flaccid paralysis
CMV
CSF CMV PCR
Tx: ganciclovir
Hemiparisis, cognitive impairment
PML - progressive multifocal leukoencephalopathy
JC virus
CNS infection
Dx: LP JC virus PCR
Toxoplasmosis is seen at what CD4 level?
CD4 < 100
CNS occupying lesion seen as ring or contrast enhancing on CT/MRI
What are the pap smear guidelines for HIV pts?
Twice in the 1st year of dx
Annually after that if no change in sxs
What is the most common cause of chronic diarrhea in HIV and how is it dx?
Cryptosporidum parvum
Watery diarrhea
Dx: modified acid fast
Pretty sure this can lead to wasting (>10% loss of body mass)
How do you treat plasmodia ovale?
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
How do p. Ovale and p. Vivax differ?
Both can lay dormant in the liver
Vivax can cause splenic rupture
Vivax needs duffy antigen to enter cells
Kopliks spot
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
Besides everybody over the age of 65, who else gets the pneumococcal vaccine?
Chronic heart, lung, liver dx EtOHism, smokers DM Immunodeficiency HIV Asplenia
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?
Endocarditis
If <60 days since surgery MC cause is staph
If >60 days since surgery MC cause is strep
What is the treatment for acute endocarditis?
Nafcillin + gentamicin x 4-6 weeks
+/- surgery:
- CHF
- systemic embolization
- uncontrolled sepsis
- myocardia abscess
- fungal infection
- +/- large vegitation
What is the treatment for subacute endocarditis?
PCN + gentamicin
Who gets tested for HIV?
Everyone at least once between 15-64yo
At risk populations
Every pregnant pts
What classes of drugs are considered first line for HIV?
2 NRTIs + 1 integrase inhibitor
With which HIV drugs MUST you add a booster to?
Protesase inhibitors
What viral load is considered undetectable?
<20 cells
Undetectable = untransmittable
You are awaiting HLAb5701 and HBV testing for a pt recently dx with HIV, what drugs should you star them on?
Dolutegravir + tenofovir/emtrictabine
When is the best time to start PEP?
Within 2 - 72 hours
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?
Women need to wait 3 weeks before meds are effective
Men need to wait 1 week before meds are effective
When do you see a blanchable macuplopapular rash in HIV pts?
During 2-4 weeks after initial infection
Primary infection
Diffuse intersitial infiltrates are seen with which pulmonary sequelae in HIV?
Pneumocysitis jiovecii
Severe decline in clinical status after ART initiation d/t inflammation response against infection (despite improved immune function)
IRIS
Which antibiotics inhibit protein synthesis?
MAT (50S, 30S, 30S)
Macrolides
Aminoglycosides
Tetracyclines
What antibiotics kill MSSA?
DON
Dicloxacillin
Oxacillin
Nafcillin
methicillin isn’t used anymore
What antibiotic can be used for VRE?
Daptomycin
Doesn’t work in lungs
What is the incubation of malaria?
1 week
ACTs
Artemisin based comibination therapies for p. Falciparum
When do you treat FUO with abx?
ONLY if they also have neutropenia
When dx endocarditis, is TTE or TEE more sensitive?
TEE
Transesophageal echo (vs transthroacic)
What is the prophylaxis used for endocarditis pt?
Amoxicillin or cephalexin 2g PO
RIPE
Rifampin + INH + PZA + ethambutol
For initial phase of TB
Also give B6 (pyridoxine)
Rickettsia ricketssi
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
Borrelia burgdorferi
Lyme disease
Same tick that causes babesiosis
Dx: ELISA + western blot
