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MID I > MID Ib > Flashcards

MID Ib Flashcards

1
Q

tx: interstitial nephritis

A

methicillin, nafcillin

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2
Q

tx: pseudomembranous colitis

A

aminopenicillins (ampicillin, amoxicillin), clindamycin

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3
Q

tx: skin rashGI distress, seizures (esp. in renally insuffiecient)

A

cerbapenems

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4
Q

tx: nephrotoxicity, ototoxicity, tertogen

A

aminoglycosides (gentamicin, tobramycin)

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5
Q

tx: skin rash, discoloration of teeth, declined bone growth

A

doxycyline

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6
Q

Tx: skin rash with hepatitis

A

macrolides (azithro, erythro)

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7
Q

tx: oragne body fluids, hepatotoxicity

A

rifampin

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8
Q

tx: rash, damaged cartilage, myalgia

A

quinolones

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9
Q

tx: megoblastic anemia, leukopenia

A

trimethoprim, sulfa

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10
Q

tx: flushing, headache, GI distress with alcohol

A

metronidazole

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11
Q

for menigitis prophylaxis, mycobacterium tuberculosis

A

rifampin

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12
Q

m: blocks mRNA synth by inhibiting RNA polymerase

A

rifampin

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13
Q

m: inhibits DNA gyrase (topoisomerase II)

A

quinolones

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14
Q

m: blocks folate synth

A

sulfas

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15
Q

m: forms free radicals by damaging DNA

A

metronidazole

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16
Q

m: inhibits protein synth. Block initiation of transcription and translation, causing misreading of mRNA

A

aminoglycosides (gentamicin, tobramycin)

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17
Q

m: inhibits protein synth. Block attachment of tRNA to ribosome

A

tetracycline

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18
Q

m: inhibits protein synth. Each interferes with distinct part.

A

streptogramins

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19
Q

m: inhibits protein synth. Prevents continuation of protein synthesis

A

macrolides, lincosamides

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20
Q

m: inhibits protein synth. Prevents peptide bonds from being formed

A

chloramphenicol

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21
Q

m: inhibits protein synth. Thought to interfere with initiation

A

linezolid (an oxazolidinone)

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22
Q

makes PBP2A (mec gene)

A

MRSA

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23
Q

deactiviated by ampC (chromosomal and inducible)

A

extended spectrum penicillins, 3rd gen cephalosporins

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24
Q

deactivated by TEM-1 and 2 beta-lactamases, ESBL

A

1st and 2nd generation cephalosporins

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25
Q

NOT deactivated by ampC

A

4th gen cephalosporin, carbepenems

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26
Q

5-10% cross hypersensitivity with penicillin (except for anaphylaxis)

A

1st gen cephalosporin

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27
Q

DO NOT use 1st gen cephalosporin for

A

MRSA, enterococci, pseudomonas, get aenerobes like bacteriodes

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28
Q

AmpC organisms: SPACE

A

Serratia, Pseudomonas (Indole+Proteus) Acinetobacter, Citrobacter, Enterobacter

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29
Q

stable for beta-lactases, except ampC and efflux pumps

A

monobactam azteonam

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30
Q

can mutate porins to prevent entry (carbepenem resistance)

A

pseudomonas

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31
Q

makes klebsiella resistant to carbepenems, for example.

A

new delhi metallo-beta-lactamase 1

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32
Q

redman if too quick, trough, dose by weight

A

vancomyocin

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33
Q

deactivated when erm gene encodes methylase that alters 23S binding site, and also by efflux pumps!

A

macrolides (azithro, erythro)

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34
Q

classic c. dif cause (though everybody does it)

A

clinamycin

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35
Q

why are anaerobes immune to aminoglycosides?

A

they lack o2 dependent transport

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36
Q

how do you outsmart aminoglycosides?

A

mutant your porin!

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37
Q

tx: myelosuppression (decreased bone marrow), esp after 3 weeks, peripheral neuropathy

A

linezolid (an oxazolidinone)

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38
Q

s. aureus turns gold in

A

mannitol test

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39
Q

exotoxin in staph scalded skin syndrome

A

exfolatin

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40
Q

Staph scalded skin syndrome does NOT affect mucous membrane, a difference from

A

Stevens-Johnsons,

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41
Q

“honey crusted lesions”

A

pyoderma (s. pyogenes)

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42
Q

“rust-colored sputum”

A

pneumonia (s.pneumoniae)

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43
Q

“tonsillar exudates”

A

GAS pharyngitis, post-infective sequelae

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44
Q

cystitis, urethritis, prostatitis

A

lower UTI

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45
Q

pyelonephritis, renal abscess

A

upper UTI

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46
Q

urine culture necessary when?

A

upper UTI, complicated UTI, pregnant, prostatitis

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47
Q

urine flow, high urine osmolarity, low urine pH, inflammatory response (PMNs, cytokines)

A

host defense from UTI

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48
Q

gram neg diplococci, kidney bean shaped, nonmotile, oxidase positive

A

gonorrhea

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49
Q

ferments only glucose, unlike Neisseria meningitidis

A

gonorrhea

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50
Q

attachment of gono, can vary to evade immune system

A

pilli

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51
Q

adhesions of gono

A

opa

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52
Q

how does gono invade? Block complement? Inhibit immune response?

A

porins, Rmp antibodies, IgA proteases

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53
Q

2nd most common bacterial STD, peak between 15-24, recurrence common

A

gonorrhea

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54
Q

incubation of gonorrhea

A

2-5 days

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55
Q

95% men are symptomatic, with dysuria, purulent discharge you can stain! 50% of women asymptomatic

A

gonorrhea!

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56
Q

diagnose gonnorhea with

A

NAAT (can culture, can gram stain discharge in men not women)

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57
Q

obligate intercellular organism, uses host ATP

A

chlamydia

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58
Q

chlamydia A-C

A

endemic trachoma

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59
Q

chlamydia D-K

A

urethritis

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60
Q

chlamydia L1-L3

A

LGV (lymphogranuloma verenium)

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61
Q

chlamydia reticulate bodies ____, elementary bodies ____.

A

replicate, enfect, enters cell via endocytosis

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62
Q

most frequently reported infectious disease in US, <25

A

chlamydia!

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63
Q

chlamydia incubation

A

2-5 days

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64
Q

most people with chlamydia

A

have no idea!

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65
Q

M: urethritis, epididymitis, prostatitis, proctitis. F: cervitis

A

chlamydia

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66
Q

painless genital ulcer, tender inguinal nodes + systemic illness, then draining sinus tracts, strictures, lymphatic obstruction

A

LGV (lymphogranuloma verenium)

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67
Q

reiter’s (uveitis, urethritis, arthritis), newborn conjunctivitis

A

other things chlamydia does

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68
Q

LGV treatment

A

21 days on eryth or dox

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69
Q

chlamydia diagnosis

A

NAAT (culture not routine, can’t gram since intracellular)

70
Q

most common STD, Icosahedral ds DNA virus

71
Q

HSV 1 v. HSV 2

A

1: orolabial, more likely to recur, 2: genitals

72
Q

HSV increases transmission of

73
Q

does it hurt to have a herpes ulcer?

74
Q

where does herpes sleep?

A

dorsal root ganglia

75
Q

herpes dx

A

DNA PCR (test lesion), serology (test blood)

76
Q

acylovir, famciclovir, valacyclovir

A

suppressive therapy daily to reduce recurrence and viral shredding

77
Q

H. ducreyi, gram negative coccobacilli, HIV major risk factor, uncommon in US

78
Q

painful ulcer, bulboes (tender swollen lymph nodes) tissue destruction

A

chancroid

“so painful, ducreyi!”

79
Q

dx chancroid

A

culture or visualization on aspiration

80
Q

treatment for chancroid

A

macrolide, cephalosporin, or quinilone

81
Q

caused by klebsiella granulomatosis, common to papua new guinea, painless, no lymphadenopathy

A

calymmaobacterium granulomatosis (STI)

82
Q

dx with smear stain for Donovan bodies, treat with Doxy x21 days

A

calymmaobacterium granulomatosis (STI)

83
Q

noninflammatory, from enterotoxin or neurotoxin, in proximal small bowel

A

watery diarrhea

84
Q

inflammatory, from cytotoxin, in colon or distal small bowel

A

bloody diarrhea

85
Q

systemic infection, in distal small bowel

A

enteric fever

86
Q

GN causes of watery diarrhea

A

vibrio cholera, enterotoxic e. coli

87
Q

GP causes of watery diarrhea

A

bacillus cereus, s. aureus, clostridium perfringens

“Swallowed the CAP”

88
Q

GN causes of bloody diarrhea

A

shigella, salmonella (non-typhi), c. jejuni, enterohemorrhagic e.coli

89
Q

GP causes of bloody diarrhea

90
Q

transmissible cause of bloody diarrhea

91
Q

GN causes of enteric fever (there are no GP)

A

Yersinia, Salmonella typhi (typhoid fever)

92
Q

transmissible causes of enteric fever

93
Q

watery diarrhea, becomes bloody, fever, tachycardia, abdominal pain, difficult to culture

94
Q

treat shigella with

A

ciprofloxacin to decrease transmission

95
Q

diarrhea, fever, voms, +/- hematuria, oliguria, edema. Culture possible

96
Q

EHEC treatment

A

fluids and wait. NO ANTIBIOTICS. Hemolytic-uremic syndrome

97
Q

HA, fever, malaise, salmon rash/rose spots, splenomegaly. Low WBC, diarrhea may process. Culture possible

A

salmonella typhi

98
Q

salmonella typhi treatment

A

ciprofloxacin

99
Q

wild diarrhea, up to 1L/hr. NO FEVER. Treat w/rehydration

100
Q

shigella, EHEC, typhoid and cholera are all

A

GNRs (legionella, too)

101
Q

gut anaerobes produce fatty acids to which many bacteria are sensitive, and more gastric acid, which schools salmonella

A

host defenses against bacterial diarrhea

102
Q

1 worldwide ID cause of death

A

pneumonia, followed by diarrhea, AIDs and TB

103
Q

pneumonia agents in infants

A

GBS, GNRs, Listeria

104
Q

pneumonia agents in children

A

pneumococcus, viruses, pertussis, atypical, h. flu

105
Q

pneumonia agents in adults

A

pneumococcus, atypicals, H flu

106
Q

typical PNA presentation

A

productive cough, fever, chills, myalgias, leukocytosis

107
Q

atypical PNA presentation

A

nonproductive cough, lower fever, milder leukocytosis, less ill appearing

108
Q

atypical PNA bugs

A

chlamydia, legionella, mycoplasma

109
Q

caves, bats, OH and MS river

110
Q

pigeon droppings

111
Q

parrots

A

chlamydia. Psittaci. Neuro symptoms!

112
Q

south western US

113
Q

animal birth

114
Q

cruise ship, hotel, plumbing

A

legionella

115
Q

ICU pneumonias

A

pneumococcus, s. aureus, legionella, GNRs

116
Q

gram neg coccobacillus, vaccine DtaP

A

bordatella pertussis

117
Q

dimorph fungi

A

histo, coccidiodes, blastomyces, sporothrix schenkii

118
Q

yeast fungi

A

crypto, candida, pityriasis versicolor

119
Q

mold fungi

A

dermatophytosis, aspergillus, mucor & rhizopus

120
Q

TB med, also used as prophylaxis, watch LFTs, give B6

A

isoniazid (INH) “(Injures Neurons and Hepatocytes!”)

121
Q

TB med, not for the pregnant!

A

pyrazinamide

122
Q

TB med: vision loss, (esp. color blindness), only bacteriostatic drug for TB

A

ethambutol

123
Q

GRN, inhabit crannies of mouth, GI, GU. Infections: sinus, oral, brain, GI GU and feet

A

bacteriodes and prevotella

124
Q

GNR, intra-abdominal infections (80%), diabetic foot ulcers. Polysaccaride capsule (adhesion, anti-phagocytosis) superoxidase dismutase/catalse, abcess

A

bacteriodes fragilis

125
Q

GPR, spores in dirt, canned food, honey

A

clostridium botulinum

126
Q

blocks Ach. Bilateral weakness, dilated pupils, dry mouth, constipating.

A

clostridium botulinum

127
Q

tr: support, clean out GI, give IgG

A

clostridium botulinum

128
Q

GPR, spores in wound from dirt. Blocks GABA, uninhibited excitation. Muscle spasm, lockjaw, sweating, labile BP, infected umbilical stump in neonates

A

clostridium tetani

129
Q

Tr: debride, metronidazole, IgG, vaccine

A

clostridium tetani

130
Q

inside healthy GI or outside (hospital). After abx, profuse watery diarrhea, leukocytosis

131
Q

dx with ELISA on PCR for toxin in stool. Treat w/PO metronidazole, PO vancomycin, fecal transplant

132
Q

feces contaminated soil, alpha toxin leads to vascular permeability, beta toxin necrotizing. See gastroenteritis, cellulitis, fasciitis, myoncrosis, pain swelling bulbae, crepitance, high CK. Treat with debridement, Abx.

A

C. perfinges “PERFinges PERForates a gangrenous leg”

133
Q

Non-spore, P. acnes, prosethetics

A

propionibacterium

134
Q

Non-spore, sulfur granules, grains of sand. Poor hygeine, chronic lesions, painless process. Treat with debridement and penicillin

A

actinomyces

135
Q

Non-spore, GI and GU, in probiotics, bacteremia/endocarditis from GU source

A

lactobacillus

136
Q

cocci: opprotunistic, often polymicrobial

A

Peptostreptococcus (+) and veillonella (-); veillonella from human bite infections

137
Q

makes vitamin K and deconjugates bile

A

Bacteriodes fragilis

138
Q

nonmotile GPR, spore forming, edema factor, lethal factor and protective antigen, incubates 1 day-2 weeks

139
Q

pruritic macule to vesicle to rounded ulcer to painless black eschar with edema, lymphopathy

140
Q

Incubates 1-100 days, fever vomiting respiratory distress, necrotizing hemorrhagic mediastinitis, fatal within 36 hours

A

inhalation anthrax

141
Q

treat with abx for 100 days or abx 30 days + 3X vaccination

A

inhalation anthrax

142
Q

spread by aersol or pustular contact, incubates 12-14 days, contagios when rash appear

143
Q

high fever, headache, back ache, rigors, malaise, 2-3 days later rash to papules to vesicles (dx w/culture, PCR, EM of lesion)

144
Q

small v. chicken: incubation

A

small is 7-14 days, chicken is 14-21

145
Q

small v. chicken: prodrome

A

small is 2-4 days, chicken is minimal

146
Q

small v. chicken: distribution

A

small is from face to arms and body, chicken is arms inward

147
Q

small v. chicken: depth of lesion

A

small is dermal, chicken is subcutaneous

148
Q

OTC: pyrethins (repeat in one week), permethrin (less allergy), malathion (irritating). Rx: topical ivermectin

A

lice and pubic lice

149
Q

what percent of pubic lice carriers have other STIs?

150
Q

extreme itch in sides, webs of fingers and toes, wrists, groin

A

scabies (itch mite)

151
Q

OTC permethrin (soap), oral ivermectin (not for pregnant!), antihistamines, topical or oral steroids

A

scabies (itch mite)

152
Q

treat all vector-infections with

A

doxycycline!

153
Q

all vector infections incubate about

154
Q

all vector illness seasons are roughly

A

summer (RMSF goes longest, April to September)

155
Q

ticks, SE, S. central US—not rockies

A

RMSF (rickettsia rickettsii)

156
Q

mites on mice in big cities

A

Rickettsial Pox (rickettsia akari)

157
Q

body lice on humans in crowded unsanitary places

A

Epidemic typhus (rickettsia prowazekii)

158
Q

lone star ticks on white tailed deer, SE s. central US

A

HME (erlchosis chafeensis)

159
Q

ticks on small mammals in NE, mid-Atlantic, upper MW, pacific NW

A

HGA (anaplasma phagocytophilum)

160
Q

ticks on small mammals in NE, upper MW

A

Lyme (borrelia burgdorferi)

161
Q

all vector illness are GN coccobacilli, except Lyme, which is

A

GN spirochete

162
Q

sudden onset flu-like, rash starts and wrists and ankles

A

rmSF (rickettsia rickettsii)

“Rickettsii on the wRists, Typhoid on the Trunk”

163
Q

Flu-like symptoms, papules like chicken pox, eschar at bite site

A

rickettsial Pox (rickettsia akari)

164
Q

acute onset fever, cough, headache, delirium, myalgia, rash starts at trunk, moves outward.

A

epidemic typhus (rickettsia prowazekii)

165
Q

mild flu-like, arthralgias, can be mild, asymptomatic, rash uncommon

A

HME (erlchosis chafeensis), HGA (anaplasma phagocytophilum)

166
Q
  1. flu-like 2. cranial nerve palsy, menigitis, radiculopathy, arthritis, heart block, pericarditis 3. recurrent arthritis, CNS/PNS. Bull’s eye rash
A

Lyme (borrelia burgdorferi)

“FAKE a key lyme pie: Facial nerve palsy, Arthritis, Kardiac block, Erythema migrans”

167
Q

If lyme is in CNS/PNS, use

A

Lyme (borrelia burgdorferi)

168
Q

what is bactrim?

A

sulfa! (TMP-SMZ)

169
Q

Rifampin’s 4 Rs

A

RNA polymerase inhibitor, Ramps up P450, Red/orange body fluids, Rapid resistance if used alone

170
Q

TB: RIPE for treatment!

A

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

171
Q

Increased Cr means

A

Muscle breakdown/reduced renal clearance

172
Q

Increased d-dimer means

A

Fibrinogen breakdown, could indicate DIC (disseminated intravascular coagulation)

MID I (8 decks)

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