Uworld Infectious Disease 10/6/2018 Flashcards
6 year old with CF has pneumonia and clubbing of the digits with a fever. What is the most likely causative organism
Staphylococcus. YES Pseudomonas pneumonia is more for CF, BUT age matters here. Staph Aureus is most common before the age of 20.
7 year old boy has malaise and head ache 2 weeks after a hiking trip and a tick bite. Rash has a red ring. What is the tx and why
AMOXICILLIN - because he is less than 8 years, and you cant use doxy in <8 kids and pregnancy.
Steps with VAP/Aspiration Pneumo
1) CXR
2) LRT sampling
3) Empiric antibiotics.
40 year old man has 2 weks of fever, malaaise, and 5 lbs weight loss. Has an asymptomatic MVP. He travels a lot. He has decreased breath sounds in lower left lung field, and 2/6 systolic murmur at apex. Labs who WBC 27000, Netup 60%, Bands 15%. IMaging shows left pleural effusion and splenic fluid collection.
INfective endocarditis which is causing a SPLENIC ABSCESS. Think IE because of the previously compromised valve.
38 F has 7 days of fatigue and headache thats getting worse. He has NO confusion, personality chages, or FND. She has thrush, bilateral papilledema, but MRI is NORMAL. What test would confirm
Cryptococcal antigen testing of CSF.
What are features of Cryptococcus Meningoencephalitis
HA, fever, over 2 weeks, papilledema, NORMAL brain MRI, HIV with CD4 <100
Initial Tx of Cryptococcal Meningoencephalitis
Amphoterecin B with FLucytosine
Maintence of Cryptococcal meningoencephalitis
Fluconazole
Pregnant patient at 10 weeks has malodorous discharge. Its gray, coats the walls, and shows numerous epithelial cells with bacteria. What is the best management, and what is it
Oral Metronidazol - she has bacterial Vaginosis.
Presentation of Plasmodium vivax aka malaria
CYCLIC Fevers, hepatosplenomegaly, and anemia.
Some features of Inf. Mono
PROLONGED fever, sore throath, jaundice, LAD, leukopenia, thrombocytopenia.
When do you NOT give Yellow Fever vaccination when they are traveleing.
Allergy to eggs, Immunocompromised <200 CD4, or under immunosupressive therapy like steroids or TNF antagonists, like methotrexate.
Kid has Septic Arthiritis - hip pain with high fever, hypotensive, and leukocytosis
What do you do FIRST
Atherocentesis. THEN empiric antibiotics.
What would be the ABX for a kid with septic arthiritis, when they are <3 months old
Nafcillin or vancomycin + Gentamicin or Cefotaxime. Need coverage for Staph, GBS, AND g - bacilli.
Abx for kid with Septic arthiritis when >3 mo
Nafcillin, Clindamycin, Cefazolin, or Vancomycin. You are just blocking Staph and Strep Species.
What would be the work up for an HIV patient with Nonbloody Diarrhea.
Stool exam for ova, eggs, parasites, cultur, C Diff and Acid Fast stain for Cryptosporidium
What would be dx in a HIV patient with bloody Diarrhea.
CMV
What would be causes of bloody diarrhea in a regular patient
Campylobacter, Shigella, E Coli
What is the dx if the patient has pneumonia WITH diarrhea? and what is teh tx
Legionella - Fluroquinolone or macrolide
What bug causes erysepalus, and what feature differs it from cellulitis
Step Pyogenes, and the swelling has sharply demarcated edges, with rapid onset. Would affect outer ear.
What causes Cellulitis, and what feature
Deep dermis and fat effect, flat edges, POOR demarcation. Fever comes later.
What would be he dx in akid with muffled speaking, neck pain, swelling on both tonsils with exudates, a WIDENED PREVERTEBRAL SPACE
Retropharyngeal abcscess
When would you have to desensitize patients to penicillin when they have a syphillis infection?
When doxy is inieffective and effecting the CNS, or are pregnant,
When would you do a CT with a dx of Pyelonephritis
When theres no change with treatement in 72 hours.
How would you differentiate Babesiosis from Lyme disease when diagnosing effects from a tick bite
In babeiosis, they will mention something about the spleen, with anemia and thrombocytopenia, increased BR. Dx with Blood smear.
Lyme - would have the characteristic rash, possibly with lymphadenopathy. Would NOT have anemia
Young mand has RUQ pain, bloody diarrhea, that resolved spontaneously, came back from mexico, and silght eosinophelia. He has a liver cyst. WHAT DO YOU GIVE
Metronidazole - he has Entomeaba hystolytica.
What is another word for “Mycobacterial Infection” thats NOT Pneumonia?
TB
Why would you still give an older adult today hepatitis A vaccine?
Kids werent given hep a vaccins until 2006.
Patient with hemochromatosis was sailing at sea, and cut his foot. He cleaned it as much as he could but now has severe cellulitis, bullous lesions around the wound, and sepsis. What is the MOST LIKELY cause?
Vibrio Vulnificus
Tx for VIbrio Vulnificus
IV ceftriaxone and Doxy
Patient has necrotizing fasciitis when working on a boat. How do you know its Vibrio Vulnificus instead of Staph or Strep?
Vibrio caused Necrotizing Fasciits happens within a few HOURS. Staph/Strep takes a few days.
What tx is for CMV?
GANcyclovir. NOT Acyclovir
