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MKSAP - Internal > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

factitious fever - findings

A

young woman pt
fever diary - unusual fever patterns (very high or brief spikes), absent diurnal variation
rapid defervescence w/o chills

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2
Q

which drugs can cause malignant hyperthermia?

A
  1. inhalational anesthetics - halothane, isoflurane, enflurane etc
  2. depolarizing mm relaxants - succinylcholine, decamethonium
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3
Q

pt develops sustained muscle contractions, skeletal mm rigidity, elevated CK and acute renal failure, tachycardia, hypercarbia, hypertension, hyperthermia, tachypneas and cardiac arrhythmias a few hours after general anesthesia…diagnosis?

A

malignant hyperthermia

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4
Q

what can you suspect in a pt w/ a family history of problems during anesthesia?

A

risk of malignant hyperthermia

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5
Q

MC offending agents in neuroleptic malignant syndrome

A

haloperidol, fluphenazine

- can occur after all D2-receptor antagonists, usually soon after starting or with dose escalation

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6
Q

in whom has neuroleptic malignant syndrome been reported in?

A

Parkinson pts who abruptly discontinue levodopa or anticholinergic therapy

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7
Q

compared to neuroleptic malignant syndrome, what findings are unique to serotonin syndrome?

A

shivering
hyperreflexia
myoclonus
ataxia

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8
Q

what is always next best step in septic pts with identified source of infection?

A

remove source of infection - indwelling catheters, drain abscess, surgical debridement

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9
Q

when can you use drotrecogin alfa (activated protein C)?

A

in severe sepsis or septic shock - APACHE score > 25 or two or more sepsis-induced organ dysfunctions (recently, shown to have no survival benefit, taken off market in 2011)

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10
Q

when should you consider using vasopressors in shock?

A

if fluid challenge fails to achieve a mean arterial pressure > 65 mmHg despite adequate fluid resuscitation (4-6L w/in 6 hours)

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11
Q

in pts with severe sepsis, what intervention will most likely improve survival?

A

aggressive fluid resuscitation w/ reduction of lactic acidosis w/in 6 hours

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12
Q

reasonable goals for fluid resuscitation (4)

A
  1. SCVO2 atleast 70%
  2. CVP of 8-12 mmHg
  3. MAP > 65 mmHg
  4. urine output atleast 0.5 ml/kg/hr
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13
Q

blood transfusion in shock pts?

A

transfusion threshold of 7g/dl is acceptable, conservative approach

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14
Q

for IV fluid resuscitation in shock, which is better…colloid or crystalloid solutions?

A

none - there is no benefit of one over the other

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15
Q

MC vasopressor used in septic shock

A

norepinephrine - potent vasocontrictor that reverses the endotoxin-induced vasodilation

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16
Q

role of Dopamine in shock

A

DA is a useful vasopressor - do not use low dose DA (no benefit on renal or other clinical outcomes)
s/e: tachycardia, arrhythmias

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17
Q

drotrecogin alfa (protein C) therapy should be considered in patients with the following criteria (3)

A
  1. septic shock requiring vasopressors/fluids
  2. sepsis-induced ARDS requiring mechanical ventilation
  3. any two sepsis-damaged organs
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18
Q

diagnostic criteria for sepsis (2)

A
  1. culture proven infection/visual ID of infection

2. evidence of systemic response to infection (fever, HR, RR, elevated WBC w/ immature band forms)

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19
Q

severe sepsis - definition

A

sepsis associated w/ organ dysfunction, hypoperfusion or hypotension

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20
Q

septic shock - definition

A

subset of severe sepsis; sepsis-induced hypotension despite adequate fluid resuscitation plus presence of perfusion abnormalities (i.e. lactic acidosis)

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21
Q

definition of SIRS (systemic inflammatory response syndrome)

A

atleast TWO of the following:

  1. fever > 38 or < 36
  2. HR > 90/min
  3. RR > 20/min or PCO2 < 32 mmHg
  4. WBC > 12000 or < 4000 or > 12% band forms
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22
Q

complications of untreated group A strep infection

A

peritonsillar abscess
poststreptococcal GN
rheumatic fever

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23
Q

pt presents with sore throat not improving on antibiotics, fever, dysphagia, pooling of saliva and drooling, muffled voice and deviation of uvula - probable diagnosis?

A

peritonsillar abscess

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24
Q

next best step if you suspect peritonsillar abscess?

A

emergency ENT consultation

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25
Q

treatment of peritonsillar abscess

A

needle drainage or surgical incision

antibiotics - ampicillin/sulbactam or parenteral penicillin G + metronidazole

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26
Q

can you recommend echinacea for prevention of URIs?

A

no - studies have failed to show consistent benefit

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27
Q

MCC of otitis media

A

strep.pneumo (followed by H.influenza and Staph aureus, Moraxella)

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28
Q

first line antibiotic for tx. of otitis media

A

amoxicillin

- oral macrolides in penicillin allergic pts

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29
Q

if sx of otitis media do not improve w/in 48-72 hrs of amoxicillin use, what should you do?

A

initiate amoxicillin-clavulanate, cefuroxime or ceftriaxone

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30
Q

Centor criteria for pharyngitis

A

estimate the probability of presence of group A strep infection

  1. fever
  2. tonsillar exudates
  3. tender anterior cervical LAD
  4. absence of cough
    - 0-1 points: no testing or tx
    - 2 points: rapid strep test
    - 3-4 points: throat culture if neg. rapid strep test; empiric ab therapy
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31
Q

tx. of choice if proven group A strep pharyngitis?

A

penicillin

- macrolides or cephalosporins if allergic

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32
Q

when should you treat sinusitis with antibiotics?

A

pt should meet atleast 2 of the following criteria:

  1. sx. > 7 days
  2. facial pain
  3. purulent nasal discharge
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33
Q

tx. of asymptomatic bacteruria in pregnancy

A

ampicillin, amoxicilin or nitrofurantoin

- obtain urine culture after tx. to confirm eradication

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34
Q

initial tx. of acute prostatitis

A

IV ciprofloxacin

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35
Q

failure of clinical improvement of acute prostatitis within 48-72 hours warrants what further tests?

A

transrectal USG or contrast enhanced CT (avoid in pts w/ renal dysfunction)

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36
Q

tx. of asymptomatic bacteruria in non-pregnant woman

A

nothing recommended

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37
Q

gold standard for dx. pyelonephritis

A

presence of bacteriuria and pyuria in association w/ history and physical exam findings

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38
Q

standard outpatient tx. of pyelonephritis

A

7-14 days of oral Fluoroquinolones (i.e. ciprofloxacin) in women who are not pregnant; pregnant women - TMP/SMX

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39
Q

tx. of recurrent cystitis in young, otherwise healthy women

A

short course antibiotic self tx. - TMP/SMX for three days

40
Q

prophylaxis of post-coital UTIs

A

ciprofloxacin

41
Q

routine screening in sexually active women under age of 25 includes

A

chlamydia, gonorrhea and HIV (opt-out)

42
Q

who should be screened for syphillis?

A
  1. all pregnant women

2. high risk pts - commercial sex workers, prisoners, any other STD, MSM, high risk behaviors

43
Q

cervicitis - definition

A

presence of mucopurulent discharge or endocervical bleeding easily induced by gentle passage of cotton swab through cervical os

44
Q

tx. of cervicitis

A

tx. empirically for gonorrhea and chlamydia

Ceftriaxone + doxycycline (or azithromycin)

45
Q

if you are treating for diagnosed gonorrhea, what else are you ALWAYS treating for?

A

chlamydia (i.e. will never have ceftriaxone alone as an answer)

46
Q

tx. of disseminated gonococcal infection

A

IV ceftriaxone

47
Q

common clinical findings of disseminated gonococcal infection

A

septic/sterile arthritis - knees, hips, wrists
tenosynovitis
sparse peripheral necrotic pustules

48
Q

diagnosis of PID

A

presence of abdominal discomfort, 1. uterine/adnexal tenderness or cervical motion tenderness

  1. temperature > 38.3
  2. cervical/vaginal mucopurulent discharge
  3. leukocytes in vaginal secretions
  4. documented gonorrhea/chlamydia infection
49
Q

tx. of PID

A

ceftriaxone and doxycycline ( w/ or w/o metronidazole) for 14 days

50
Q

when do you hospitalize a pt with PID? (6)

A
  1. no response to antibiotics w/in 48-72 hrs
  2. inability to tolerate PO antibiotics
  3. severe illness w/ NV or high fever
  4. suspected intraabdominal abscess
  5. pregnancy
  6. noncompliance w/ outpatient therapy
51
Q

when do you add steroids to tx. of PCP pneumonia?

A

add steroids if pt has evidence of hypoxia

- PaO2 35 mmHg

52
Q

tx. of PCP pneumonia

A

TMP-SMX for 3 weeks

- add steroids if evidence of hypoxia

53
Q

prophylaxis in AIDs pt with CDC < 200

A

TMP-SMX for PCP pneumonia

54
Q

prophylaxis in AIDs pt with CDC < 100

A

TMP-SMX for both PCP and toxoplasmosis

55
Q

prophylaxis in AIDs pt with CDC < 50

A

TMP-SMX - for pcp and toxoplasmosis

azithromycin - for MAC

56
Q

Dapsone - use in AIDs

A
  1. adjunctive tx. to TMP-SMX in acute PCP

2. alone as prophylactic agent for pts w/ cdc < 200 and intolerant of TMP-SMX

57
Q

pt presents with recurrent Herpes Zoster (shingles) infection - what should you consider?

A

HIV infection (also pts on chemotherapy or who have undergone organ transplant - but this is less likely)

58
Q

Tx. of recurrent herpes zoster in HIV pts

A

oral valacyclovir or famciclovir

- if severe or disseminated, IV acyclovir may be needed

59
Q

most sensitive test for HIV infection in the acute stage

A

HIV viral RNA load

60
Q

what two diseases should be considered in sexually active pts with rash, fever and generalized LAD?

A

secondary syphillis

acute retroviral syndrome

61
Q

HIV positive pt presents with fever, neurological deficits and MRI showing ring-enhancing lesions; CDC < 100; dx?

A

toxoplasmosis

62
Q

Tx. approach of suspected toxoplasmosis in HIV pt

A

pyrimethamine + sulfadiazine and folinic acid given for 14 days –> do follow up MRI to assess tx. response; if there is no response, consider stereotactic brain biopsy

63
Q

MC form of meningitis in AIDs pts

A

cryptococcal meningitis (w/ CDC < 100)

64
Q

dx. of cryptococcal meningitis

A

cryptococcal antigen in CSF or culture of organism in CSF

65
Q

HIV pt presents with fever, weight loss, hepatosplenomegaly, LAD, malaise and abdominal pain; CDC < 50 - dx?

A

disseminated MAC

66
Q

HIV pt presents with dementia, hemiparesis/paralysis of one extremity, ataxia, hemianopia and diplopia - dx?

A

progressive multifocal leukoencephalopathy (demyelinating disease of CNS exclusivey seen in severely immunocompromised pts)

67
Q

MRI appearance of PML lesions

A

T2/FLAIR sequences - hyperintense areas

T1 - hypointense areas

68
Q

most effective way to prevent catheter-associated UTIs

A

decrease catheter use - only use for specific indications and remove as soon as possible

69
Q

what measure can be taken to prevent Ventilator-Associated Pneumonia?

A

semi-erect positioning at 45 degrees

70
Q

placement of endotracheal tube in what position is superior?

A

oral&raquo_space; nasal } nasal can predispose to nosocomial sinusitis

71
Q

what is the “bundle” of precautions that should be taken to reduce C.difficle transmission in hospital?

A

barrier precautions - nonsterile gown/gloves
enhanced cleaning w/ bleach
soap and water hand washing

72
Q

droplet precautions should be used for what types of infections?

A

illnesses transmitted by large particle i.e. Neisseria meningitidis, influenza
- pts are isolated and personnel wear face masks when within 3 feet of pt

73
Q

airborne precautions to be taken when you suspect diagnosis of TB

A

placement of pt in a negative pressure room

use of respiratory protection by health care workers (N95 masks)

74
Q

next step in someone who has a positive PPD?

A

chest XRay

- if XR findings are negative, tx. for latent infection with isoniazid + B6 for 9 months

75
Q

initial treatment in pts with suspective or confirmed active TB

A

4 drug regimen: isoniazid, rifampin, ethambutol and pyrazinamide (for 2 months), then isoniazid and rifampin for another 7 months (total 9 months)

76
Q

an induration of 5 mm or more after PPD is considered positive in what groups of people?

A

HIV, immunosuppressed pts, persons in close contact with active TB, abnormal CXR, pts on immunosuppressive agents

77
Q

induration of 10 mm or more on PPD is considered positive in…

A

IVDA, prisoners, health care workers, pts with silicosis, DM, CRF, leukemia/lymphoma, carcinoma of head, neck or lung, recent significant weight loss, history of gastrectomy or jejunoileal bypass

78
Q

what should you do before initiating treatment with a TNFa inhibitor (infliximab, etanercept, adalimumab)?

A

screen with PPD - if > 5 mm induration or positive interferon-gamma assay, treat for latent TB with isoniazid for 9 months; at least 2 months of isoniazid before starting infliximab

79
Q

when should you suspect community-acquired MRSA pneumonia?

A
  1. pts with severe, rapidly progressive pneumonia, esp during influenza season
  2. pts with cavitary infiltrates on CXR
  3. pts with a history of MRSA infection
80
Q

empiric antibiotic therapy for suspected MRSA pneumonia

A

cefotaxime, levofloxacin, vancomycin

81
Q

pt presents with nonproductive cough, chest pain, GI symptoms (diarrhea), high fever (> 40C) and hyponatremia; pt shows signs of obtundation such as lethargy and headache- dx?

A

Legionnaire’s disease - legionella

82
Q

how do you diagnose legionella pneumonia?

A

urinary antigen test

83
Q

risk factors for Legionnaire’s disease

A 
smoking
diabetes mellitus
hematologic malignancy and other cancers
chronic kidney disease
HIV infection
84
Q

first line tx for community acquired pneumonia (mild)

A

macrolides - azithromycin or clarithromycin

85
Q

tx. of lung abscess following aspiration

A

ampicillin-sulbactam

86
Q

who should receive prophylaxis against infective endocarditis before dental procedures?

A
  1. prosthetic cardiac valves
  2. history of prior IE
  3. unrepaired cyanotic congenital heart disease
  4. repaired congenital heart disease for 6 months following repair
  5. cardiac transplantation recipients with valvulopathy
87
Q

drug of choice for prophylaxis of IE

A

oral amoxicillin - given 30-60 minutes prior to procedure; if unable to take oral meds, given ampicillin, cefazolin or ceftriaxone IM/IV

88
Q

drug of choice for prophylaxis of IE in penicillin-allergic pts

A

oral clindamycin, azithromycin or clarithromycin

89
Q

tx. of tricuspid valve endocarditis in an IVDA

A

tx. for staph aureus –> vancomycin + cefipime

90
Q

Tx. of penicillin-sensitive viridans strep on native valves (endocarditis)

A

4 weeks with either penicillin or ceftriaxone OR 2 weeks when either agent is combined with low-dose gentamicin

91
Q

tx. of methicillin-susceptible staph aurea bactermia and endocarditis

A

synthetic penicllins, oxacillin and nafcillin

92
Q

what is contact with bone using a sterile, blunt steel probe in an infected pedal ulcer is correlated with what?

A

underlying osteomyelitis (esp. in pt with DM)

93
Q

how do you diagnose osteomyelitis of the foot in a patient with diabetes?

A

bone biopsy –> cultures obtained from sinus tract or ulcer base do not reflect the bacterial etiology of deep pathogens

94
Q

what should you consider in any patient with new onset back pain and fever?

A

vertebral osteomyelitis

95
Q

imaging study of choice for pts with suspected vertebral osteomyelitis

A

MRI

- if MRI cannot be performed (pt with pacemaker or metal prosthetic device) - do a gallium scan

96
Q

when would you do a three-phase bone scintigraphy study in osteomyelitis?

A

when initial MRI imaging results are indeterminate

97
Q

pt has MRI findings suggestive of osteomyelitis…what is the next step?

A

blood cultures - positive in 75% of pts (needed to guide treatment); if cultures negative, consider CT-guided percutaneous needle biopsy

MKSAP - Internal (11 decks)

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