MID Ib Flashcards
1
Q
tx: interstitial nephritis
A
methicillin, nafcillin
2
Q
tx: pseudomembranous colitis
A
aminopenicillins (ampicillin, amoxicillin), clindamycin
3
Q
tx: skin rashGI distress, seizures (esp. in renally insuffiecient)
A
cerbapenems
4
Q
tx: nephrotoxicity, ototoxicity, tertogen
A
aminoglycosides (gentamicin, tobramycin)
5
Q
tx: skin rash, discoloration of teeth, declined bone growth
A
doxycyline
6
Q
Tx: skin rash with hepatitis
A
macrolides (azithro, erythro)
7
Q
tx: oragne body fluids, hepatotoxicity
A
rifampin
8
Q
tx: rash, damaged cartilage, myalgia
A
quinolones
9
Q
tx: megoblastic anemia, leukopenia
A
trimethoprim, sulfa
10
Q
tx: flushing, headache, GI distress with alcohol
A
metronidazole
11
Q
for menigitis prophylaxis, mycobacterium tuberculosis
A
rifampin
12
Q
m: blocks mRNA synth by inhibiting RNA polymerase
A
rifampin
13
Q
m: inhibits DNA gyrase (topoisomerase II)
A
quinolones
14
Q
m: blocks folate synth
A
sulfas
15
Q
m: forms free radicals by damaging DNA
A
metronidazole
16
Q
m: inhibits protein synth. Block initiation of transcription and translation, causing misreading of mRNA
A
aminoglycosides (gentamicin, tobramycin)
17
Q
m: inhibits protein synth. Block attachment of tRNA to ribosome
A
tetracycline
18
Q
m: inhibits protein synth. Each interferes with distinct part.
A
streptogramins
19
Q
m: inhibits protein synth. Prevents continuation of protein synthesis
A
macrolides, lincosamides
20
Q
m: inhibits protein synth. Prevents peptide bonds from being formed
A
chloramphenicol
21
Q
m: inhibits protein synth. Thought to interfere with initiation
A
linezolid (an oxazolidinone)
22
Q
makes PBP2A (mec gene)
A
MRSA
23
Q
deactiviated by ampC (chromosomal and inducible)
A
extended spectrum penicillins, 3rd gen cephalosporins
24
Q
deactivated by TEM-1 and 2 beta-lactamases, ESBL
A
1st and 2nd generation cephalosporins
25
NOT deactivated by ampC
4th gen cephalosporin, carbepenems
26
5-10% cross hypersensitivity with penicillin (except for anaphylaxis)
1st gen cephalosporin
27
DO NOT use 1st gen cephalosporin for
MRSA, enterococci, pseudomonas, get aenerobes like bacteriodes
28
AmpC organisms: SPACE
Serratia, Pseudomonas (Indole+Proteus) Acinetobacter, Citrobacter, Enterobacter
29
stable for beta-lactases, except ampC and efflux pumps
monobactam azteonam
30
can mutate porins to prevent entry (carbepenem resistance)
pseudomonas
31
makes klebsiella resistant to carbepenems, for example.
new delhi metallo-beta-lactamase 1
32
redman if too quick, trough, dose by weight
vancomyocin
33
deactivated when erm gene encodes methylase that alters 23S binding site, and also by efflux pumps!
macrolides (azithro, erythro)
34
classic c. dif cause (though everybody does it)
clinamycin
35
why are anaerobes immune to aminoglycosides?
they lack o2 dependent transport
36
how do you outsmart aminoglycosides?
mutant your porin!
37
tx: myelosuppression (decreased bone marrow), esp after 3 weeks, peripheral neuropathy
linezolid (an oxazolidinone)
38
s. aureus turns gold in
mannitol test
39
exotoxin in staph scalded skin syndrome
exfolatin
40
Staph scalded skin syndrome does NOT affect mucous membrane, a difference from
Stevens-Johnsons,
41
“honey crusted lesions”
pyoderma (s. pyogenes)
42
“rust-colored sputum”
pneumonia (s.pneumoniae)
43
“tonsillar exudates”
GAS pharyngitis, post-infective sequelae
44
cystitis, urethritis, prostatitis
lower UTI
45
pyelonephritis, renal abscess
upper UTI
46
urine culture necessary when?
upper UTI, complicated UTI, pregnant, prostatitis
47
urine flow, high urine osmolarity, low urine pH, inflammatory response (PMNs, cytokines)
host defense from UTI
48
gram neg diplococci, kidney bean shaped, nonmotile, oxidase positive
gonorrhea
49
ferments only glucose, unlike Neisseria meningitidis
gonorrhea
50
attachment of gono, can vary to evade immune system
pilli
51
adhesions of gono
opa
52
how does gono invade? Block complement? Inhibit immune response?
porins, Rmp antibodies, IgA proteases
53
2nd most common bacterial STD, peak between 15-24, recurrence common
gonorrhea
54
incubation of gonorrhea
2-5 days
55
95% men are symptomatic, with dysuria, purulent discharge you can stain! 50% of women asymptomatic
gonorrhea!
56
diagnose gonnorhea with
NAAT (can culture, can gram stain discharge in men not women)
57
obligate intercellular organism, uses host ATP
chlamydia
58
chlamydia A-C
endemic trachoma
59
chlamydia D-K
urethritis
60
chlamydia L1-L3
LGV (lymphogranuloma verenium)
61
chlamydia reticulate bodies ____, elementary bodies ____.
replicate, enfect, enters cell via endocytosis
62
most frequently reported infectious disease in US, <25
chlamydia!
63
chlamydia incubation
2-5 days
64
most people with chlamydia
have no idea!
65
M: urethritis, epididymitis, prostatitis, proctitis. F: cervitis
chlamydia
66
painless genital ulcer, tender inguinal nodes + systemic illness, then draining sinus tracts, strictures, lymphatic obstruction
LGV (lymphogranuloma verenium)
67
reiter's (uveitis, urethritis, arthritis), newborn conjunctivitis
other things chlamydia does
68
LGV treatment
21 days on eryth or dox
69
chlamydia diagnosis
NAAT (culture not routine, can't gram since intracellular)
70
most common STD, Icosahedral ds DNA virus
Herpes!
71
HSV 1 v. HSV 2
1: orolabial, more likely to recur, 2: genitals
72
HSV increases transmission of
HIV
73
does it hurt to have a herpes ulcer?
yes
74
where does herpes sleep?
dorsal root ganglia
75
herpes dx
DNA PCR (test lesion), serology (test blood)
76
acylovir, famciclovir, valacyclovir
suppressive therapy daily to reduce recurrence and viral shredding
77
H. ducreyi, gram negative coccobacilli, HIV major risk factor, uncommon in US
chancroid
78
painful ulcer, bulboes (tender swollen lymph nodes) tissue destruction
chancroid
| "so painful, ducreyi!"
79
dx chancroid
culture or visualization on aspiration
80
treatment for chancroid
macrolide, cephalosporin, or quinilone
81
caused by klebsiella granulomatosis, common to papua new guinea, painless, no lymphadenopathy
calymmaobacterium granulomatosis (STI)
82
dx with smear stain for Donovan bodies, treat with Doxy x21 days
calymmaobacterium granulomatosis (STI)
83
noninflammatory, from enterotoxin or neurotoxin, in proximal small bowel
watery diarrhea
84
inflammatory, from cytotoxin, in colon or distal small bowel
bloody diarrhea
85
systemic infection, in distal small bowel
enteric fever
86
GN causes of watery diarrhea
vibrio cholera, enterotoxic e. coli
87
GP causes of watery diarrhea
bacillus cereus, s. aureus, clostridium perfringens
"Swallowed the CAP"
88
GN causes of bloody diarrhea
shigella, salmonella (non-typhi), c. jejuni, enterohemorrhagic e.coli
89
GP causes of bloody diarrhea
C. diff
90
transmissible cause of bloody diarrhea
shigella
91
GN causes of enteric fever (there are no GP)
Yersinia, Salmonella typhi (typhoid fever)
92
transmissible causes of enteric fever
S. typhi
93
watery diarrhea, becomes bloody, fever, tachycardia, abdominal pain, difficult to culture
shigella
94
treat shigella with
ciprofloxacin to decrease transmission
95
diarrhea, fever, voms, +/- hematuria, oliguria, edema. Culture possible
EHEC
96
EHEC treatment
fluids and wait. NO ANTIBIOTICS. Hemolytic-uremic syndrome
97
HA, fever, malaise, salmon rash/rose spots, splenomegaly. Low WBC, diarrhea may process. Culture possible
salmonella typhi
98
salmonella typhi treatment
ciprofloxacin
99
wild diarrhea, up to 1L/hr. NO FEVER. Treat w/rehydration
cholera
100
shigella, EHEC, typhoid and cholera are all
GNRs (legionella, too)
101
gut anaerobes produce fatty acids to which many bacteria are sensitive, and more gastric acid, which schools salmonella
host defenses against bacterial diarrhea
102
#1 worldwide ID cause of death
pneumonia, followed by diarrhea, AIDs and TB
103
pneumonia agents in infants
GBS, GNRs, Listeria
104
pneumonia agents in children
pneumococcus, viruses, pertussis, atypical, h. flu
105
pneumonia agents in adults
pneumococcus, atypicals, H flu
106
typical PNA presentation
productive cough, fever, chills, myalgias, leukocytosis
107
atypical PNA presentation
nonproductive cough, lower fever, milder leukocytosis, less ill appearing
108
atypical PNA bugs
chlamydia, legionella, mycoplasma
109
caves, bats, OH and MS river
histo
110
pigeon droppings
crypto
111
parrots
chlamydia. Psittaci. Neuro symptoms!
112
south western US
coccidio
113
animal birth
coxiella
114
cruise ship, hotel, plumbing
legionella
115
ICU pneumonias
pneumococcus, s. aureus, legionella, GNRs
116
gram neg coccobacillus, vaccine DtaP
bordatella pertussis
117
dimorph fungi
histo, coccidiodes, blastomyces, sporothrix schenkii
118
yeast fungi
crypto, candida, pityriasis versicolor
119
mold fungi
dermatophytosis, aspergillus, mucor & rhizopus
120
TB med, also used as prophylaxis, watch LFTs, give B6
isoniazid (INH) "(Injures Neurons and Hepatocytes!")
121
TB med, not for the pregnant!
pyrazinamide
122
TB med: vision loss, (esp. color blindness), only bacteriostatic drug for TB
ethambutol
123
GRN, inhabit crannies of mouth, GI, GU. Infections: sinus, oral, brain, GI GU and feet
bacteriodes and prevotella
124
GNR, intra-abdominal infections (80%), diabetic foot ulcers. Polysaccaride capsule (adhesion, anti-phagocytosis) superoxidase dismutase/catalse, abcess
bacteriodes fragilis
125
GPR, spores in dirt, canned food, honey
clostridium botulinum
126
blocks Ach. Bilateral weakness, dilated pupils, dry mouth, constipating.
clostridium botulinum
127
tr: support, clean out GI, give IgG
clostridium botulinum
128
GPR, spores in wound from dirt. Blocks GABA, uninhibited excitation. Muscle spasm, lockjaw, sweating, labile BP, infected umbilical stump in neonates
clostridium tetani
129
Tr: debride, metronidazole, IgG, vaccine
clostridium tetani
130
inside healthy GI or outside (hospital). After abx, profuse watery diarrhea, leukocytosis
C. diff
131
dx with ELISA on PCR for toxin in stool. Treat w/PO metronidazole, PO vancomycin, fecal transplant
C. diff
132
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.
C. perfinges "PERFinges PERForates a gangrenous leg"
133
Non-spore, P. acnes, prosethetics
propionibacterium
134
Non-spore, sulfur granules, grains of sand. Poor hygeine, chronic lesions, painless process. Treat with debridement and penicillin
actinomyces
135
Non-spore, GI and GU, in probiotics, bacteremia/endocarditis from GU source
lactobacillus
136
cocci: opprotunistic, often polymicrobial
Peptostreptococcus (+) and veillonella (-); veillonella from human bite infections
137
makes vitamin K and deconjugates bile
Bacteriodes fragilis
138
nonmotile GPR, spore forming, edema factor, lethal factor and protective antigen, incubates 1 day-2 weeks
anthrax
139
pruritic macule to vesicle to rounded ulcer to painless black eschar with edema, lymphopathy
anthrax
140
Incubates 1-100 days, fever vomiting respiratory distress, necrotizing hemorrhagic mediastinitis, fatal within 36 hours
inhalation anthrax
141
treat with abx for 100 days or abx 30 days + 3X vaccination
inhalation anthrax
142
spread by aersol or pustular contact, incubates 12-14 days, contagios when rash appear
small pox
143
high fever, headache, back ache, rigors, malaise, 2-3 days later rash to papules to vesicles (dx w/culture, PCR, EM of lesion)
small pox
144
small v. chicken: incubation
small is 7-14 days, chicken is 14-21
145
small v. chicken: prodrome
small is 2-4 days, chicken is minimal
146
small v. chicken: distribution
small is from face to arms and body, chicken is arms inward
147
small v. chicken: depth of lesion
small is dermal, chicken is subcutaneous
148
OTC: pyrethins (repeat in one week), permethrin (less allergy), malathion (irritating). Rx: topical ivermectin
lice and pubic lice
149
what percent of pubic lice carriers have other STIs?
30.00%
150
extreme itch in sides, webs of fingers and toes, wrists, groin
scabies (itch mite)
151
OTC permethrin (soap), oral ivermectin (not for pregnant!), antihistamines, topical or oral steroids
scabies (itch mite)
152
treat all vector-infections with
doxycycline!
153
all vector infections incubate about
one week
154
all vector illness seasons are roughly
summer (RMSF goes longest, April to September)
155
ticks, SE, S. central US—not rockies
RMSF (rickettsia rickettsii)
156
mites on mice in big cities
Rickettsial Pox (rickettsia akari)
157
body lice on humans in crowded unsanitary places
Epidemic typhus (rickettsia prowazekii)
158
lone star ticks on white tailed deer, SE s. central US
HME (erlchosis chafeensis)
159
ticks on small mammals in NE, mid-Atlantic, upper MW, pacific NW
HGA (anaplasma phagocytophilum)
160
ticks on small mammals in NE, upper MW
Lyme (borrelia burgdorferi)
161
all vector illness are GN coccobacilli, except Lyme, which is
GN spirochete
162
sudden onset flu-like, rash starts and wrists and ankles
rmSF (rickettsia rickettsii)
| "Rickettsii on the wRists, Typhoid on the Trunk"
163
Flu-like symptoms, papules like chicken pox, eschar at bite site
rickettsial Pox (rickettsia akari)
164
acute onset fever, cough, headache, delirium, myalgia, rash starts at trunk, moves outward.
epidemic typhus (rickettsia prowazekii)
165
mild flu-like, arthralgias, can be mild, asymptomatic, rash uncommon
HME (erlchosis chafeensis), HGA (anaplasma phagocytophilum)
166
1. flu-like 2. cranial nerve palsy, menigitis, radiculopathy, arthritis, heart block, pericarditis 3. recurrent arthritis, CNS/PNS. Bull's eye rash
Lyme (borrelia burgdorferi)
| "FAKE a key lyme pie: Facial nerve palsy, Arthritis, Kardiac block, Erythema migrans"
167
If lyme is in CNS/PNS, use
Lyme (borrelia burgdorferi)
168
what is bactrim?
sulfa! (TMP-SMZ)
169
Rifampin's 4 Rs
RNA polymerase inhibitor, Ramps up P450, Red/orange body fluids, Rapid resistance if used alone
170
TB: RIPE for treatment!
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
171
Increased Cr means
Muscle breakdown/reduced renal clearance
172
Increased d-dimer means
Fibrinogen breakdown, could indicate DIC (disseminated intravascular coagulation)
