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Step 2 > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

Criteria for in patient, IV tx for pneumona

A

> 65, comorbidities (ETOH, COPD, DM, malnutr), immunospr, malignancy, unstable vitals, AMS, multilobular

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2
Q

Empiric coverage: outpatient CAP

A

macrolide (eg azithromycin) or doxycycline

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3
Q

Empiric coverage: CAP requiring hosp

A

flouroquinolone or antipneumococcal b-lactam (eg piperacillin, ceftazidime) + macrolide (eg azithromycin)

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4
Q

Empiric coverage: CAP requiring ICU

A

antipneumococcal b-lactam (eg piperacillin, ceftazidime) + azithromycin or flouroquinolone

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5
Q

Empiric coverage: pneunomonia, critically ill, not responding to abx

A

vancomycin or linezolid, broad gram neg coverage

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6
Q

Empiric coverage: HAP

A

Extended-spectrum cephalosporin or carbapenem with antispeudomonal activity
Add aminoglycoside or flouroquinolone while sensitivity pending

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7
Q

Tb findings for normal host, immunocompr

A

Normal host: cavitary infiltrate upper lobe
Immunocompr, primary tb: lower lobe infiltrates, can be without cavitation
Miliary tb: multiple fine nodular densities

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8
Q

Tx: active and latent Tb

A

Active: 4x therapy (INH, pyriazinamide, rifampin, ethambutol) x2mo, INH+ rifampin x4mo
Latent: INHx9mo or rifampinx4mo

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9
Q

Common side effects:

  • Rifampin
  • Ethambutol
  • INH
A
  • Rifampin: turns fluids orange, P450 inducer
  • Ethambutol: optic neuritis
  • INH: peripheral neuropathy, hepatitis
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10
Q

Therapy for GAS

A

penicillin x10d

cephalosoprin, amoxicillin, azithromycin= alternatives

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11
Q

Lemierre’s syndrome: defn, causative organsm

A

Thrombophlebitis of jugular vein after pharyngitis

fusobacterium (oral anaerobe)

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12
Q

odynophagia, trismus, muffled voice, asymmetric uvula: dx and tx

A

peritonsallar abscess, US or CT + Cx

Abx + surgical drainage

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13
Q

HIV+, filipin, Af Am, pregnant from SW US who present with respiratory infxn: dx and tx

A

Coccidiomycoisis
Tx: PO fluconazole or itraconozaole
IV amphotericin B for severe
progressive symptomatic disease: surgery+ long term azole (8-12mo)

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14
Q

Meningococcal meningitis: Ppx and tx

A

Ppx: rifampin
Tx: ceftriaxone

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15
Q

Important adjunctive treatment for meningitis

A

Dexamethasone: (esp S. pneumo, H flu), give 15-20min before abx

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16
Q

Cerebral edema: dx tests and tx

A

loss oculocephalic reflex
CT/MRI
tx: IV mannitol

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17
Q

subdural empyema: presentation and tx

A

intractable seizures

Tx: surgical evacuation

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18
Q

CSF findings: bacterial vs viral menigitis

A

Bacterial: incr WBC (>1000 PMNs), decr glc, incr prot (>45) and opening pressures (>20)
Viral: Incr WBCs (mono/lymph), prot and opening pressure may be incr or normal

19
Q

CSF finding: MS

A

incr gamma globulin

20
Q

RBCs in CSF without a hx of trauma

A

HSV encephalitis

21
Q

India ink stain (CSF)

A

cryptococcus

22
Q

Giemsa stain (CSF)

A

trypnaosomes

23
Q

Empiric treatment: meningitis

A

ampicillin + cefotaxime or gentamicin

24
Q

Empiric treatment: Meningitis >1mo-adult

A

vancomycin + cetriaxone or cefotaxime

25
Q

Empiric treatment: meningitis >60/ETOH

A

ampicillin + vancomycin + cefotaxime or cetriaxone

26
Q

cranial nerve defects assoc with incr ICP, nature of headache

A

CN III, VI

27
Q

headache, fever, local neuro deficit: dx and tx

A

typical of brain abscess (consider brain met if no fever)
Surgical drainage if >2cm
3rd gen cephalosporin (ceftazidime, ceftriaxone) + metronidazole +/- vancomycin (6-8wks)
Dexa/ IV mannitol

28
Q

When start HAART, what use?

A

symptomatic pt, CD4

29
Q

pseudohyphae + budding yeast, germ tupes at 37 deg: dx and tx

A

candida

PO azole

30
Q

45 deg branching septate hyphae with rare fruiting bodies: dx and tx

A

aspergillus

31
Q

5-10mm wide capsular halo with narrow-based unequal budding: dx and tx

A

cryptococcus

IV amphotericin B + flucytosine for 2 wks, fluconazoel x 8wks (for meningitis)

32
Q

Irregular broad nonseptate hyphae with wide-angle branching: dx and tx

A

mucor

33
Q

fever, weight loss, HSM, LAD, cough, palatal ulcers, ohio or spelunking: dx and tx

A

histoplasmosis
urine and serum polysaccharide antigen
Mild: itraconazle (cavitary lesion- >1yr)
severe/ dissem: amphtericin B x 14 d then itraconazole

34
Q

“pizza pie” retinopathy with retinal detachment

floaters and visual field changes

A

CMV retinitis

tx: ganciclovir or foscarnet

35
Q

Polyradiculopathy, transverse myelitis, subacute encephailtis in immunocompr

A

CNS involv CMV

36
Q

fever, weakness, weight loss in immunocomp, anemia, incr alk phos and LDH: dx, tx (ppx and tx)

A

MAC
Bx: foamy macrophages with acid-fast bacilli
Tx: clarithromycin or ehtambutol +/- refabutin
ppx: azithromycin (CD4

37
Q

Isodense or hypodense ring-enhancing mass lesions with predilection for basal ganglia: dx and tx

A

toxo
tx: pyrimethamine + sulfadiazine or leucovorin x 4-8wks
TMP -SMX ppx (CD4

38
Q

anal pruritis with discharge, rectal strictures, rectovaginal fistula, elephantitis: dx

A

anogenital syndrome, tertiary lynphogranuloma venerium (chlamydia)
tx: doxy or azithromycin once; prolonged tx 21d

39
Q

monoarticular septic arthrit, rash (hemorrhagic, panful pustules with erythematous bases), tenosynovitis: dx and tx

A

gonorrhea (disseminated

IV cetriaxone for at least 24h

40
Q

hypotension with warm skin and extremities: dx and tx

A

septic shock

IVF, empiric abx, vasopressors

41
Q

periodic fevers/ chills (>105.8), dipahoresis, splenomegally: dx, workup, tx (+ ppx)

A

Malaria (P falciparum- highest morbidity, vivax, ovale, malariae)
Giemsa or Wright-stained thick and thin blood films
cholroquine= standard tx
primaquien for p vivax or p ovale (to eradicate liver hynpozoites)
Severe infxn IV quinidine
Mefloquine for chemoprophylaxis

42
Q

headache, fever, malaise, macular rash that starts and wrists/ankles and spreads ceantrally: dx and tx

A

rocky mountain spotted fever (reikettsia rickettsii) via american dog tick
tx: doxy or chloramphenical (for pregnant)

43
Q

conjunctivitis, gram stain shows gram neg intracell diplococci: dx and tx

A

N. gnorrhea, IM ceftriaxione, PO cipro or oxfloxacin emergently

44
Q

Recurrent epithelial keratitis in children, + giemsa stain: dx and tx

A

C. tracomatis

Axithromycin, tetracycline or erythromiycin for 3-4 wks

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