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Family Medicine: Case Files > EH: Infectious Disease > Flashcards

EH: Infectious Disease Flashcards

1
Q

Meningitis, Most Common Bugs?

Tx?

A

Strep Pneumo, H. Influenza, N. meningitidis

(tx w/ Ceftriaxone and Vanco)

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2
Q

Meningitis

In old and young?

A

Strep Pneumo, H. Influenza, N. meningitidis

(tx w/ Ceftriaxone and Vanco)

Add Lysteria. (tx w/ Ampicillin)

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3
Q

Meningitis

In ppl w/ brain surg?

A

Add Staph auerus

(tx w/ Vanco)

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4
Q

Meningitis

Randoms?

A

TB (RIPE + ‘roids) and Lyme (IV ceftriazone)

Rifampin + Isoniazid + Pyrazinamide ± Ethambutol or Streptomycin

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5
Q

Meningitis

Best 1st step?

A

Start empiric treatment (+ steroids if you think it is bacterial), Exam for elevated ICP/CT, then LP

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6
Q

Meningitis

Diagnostic test?

A

+Gram stain, >1000 WBC is diagnostic.

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7
Q

Meningitis

Roommate of the kid in the dorms who has bacterial meningitis and petechial rash?

A

Rifampin

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8
Q

Pneumonia

Classic sxs… best 1st step?

A

CXR

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9
Q

Pneumonia

Most common bug all comers?

A

Strep Pneumo.

Tx w/ M, FQ, 3rd ceph

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10
Q

Pneumonia

Most common bug in in Young, Healthy People?

A

Mycoplasma

A/w cold agglutinins

Tx: w/ M, FQ, and Doxy

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11
Q

Pneumonia

Old smokers w/ COPD?

A

H. influenzae. Tx w/ 2nd-3rd ceph

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12
Q

Pneumonia

Alcoholics w/ current jelly sputum?

A

Klebsiella. Tx w/ 3rd ceph

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13
Q

Pneumonia

Old men w/ HA, confusion, diarrhea and abd pain?

A

Legionella

Dx w/ urine antigen.

Tx w/ M, FQ, doxy

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14
Q

Pneumonia

Just had the flu?

A

MRSA.

Tx w/ vanc

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15
Q

Pneumonia

Just delivered a baby cow and have vomiting and diarrhea?

A

Q-fever. Coxiella burnetti.

Tx w/ doxy

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16
Q

Pneumonia

Just skinned a rabbit?

A

Franciella tularensis.

Tx w/ streptamycin, gentamycin

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17
Q

TB

If a patient is symptomatic best test is ?

A

CXR

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18
Q

TB for Screening?

A

For screening

  • >15mm
  • >10mm if prison
  • Healthcare, nursing home, DM, ETOH, Chronically ill,
  • >5mm for AIDS, Immune suppressed

– If + PPD –> do CXR.

– If + CXR –> do a acid fast stain of sputum.

– If CXR negative, or + CXR & 3 negative sputums

– If positive –> Tx w/ 4 drug RIPE Regimen for 6mo (12 for meningitis and 9 if pregnant)

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19
Q

Side effects of Rifampin?

A

Body fluids turn orange/red, induces CYP450

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20
Q

Side effects of Isoniazid (INH)?

A

Peripheral Neuropaty and Sideroblastic anemia

Prevent by giving B6. Hepatitis w/ mild bump in LFTs

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21
Q

Side effects of Pyrazinamide?

A

Benign hyperuricemia

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22
Q

Side effects of Ethambutol ?

A

Optic neuritis, other color vision abnormalities.

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23
Q

Acute endocarditis most common bug?

A

Staph aureus seeds native valves from bacteremia

24
Q

Subacute Native valve endocarditis-

Most common valve?

A

Mitral Valve (MVP is MC predisposition)

25
Q

Subacute Native valve endocarditis-

Most common bug?

A

Viridens group strep

26
Q

Intravenous Drug Use (IVDU)

Most common valve?

A

Tricuspid Valve (murmur worse w/ inspiration)

27
Q

IVDU

Most common bug?

A

Staph Aureus

28
Q

IVDU

Diagnosis?

A

Blood cx

TTE then TEE

Transthoracic Ecocardiography
then Transesophogeal Echocardiography

Major and Minor Criteria

29
Q

IVDU

Complications?

A

CHF #1 cause of death, septic emboli to lungs or brain

30
Q

IVDU

Treatment?

A

Strep Viridens = 4-6 wks PCN

Staph = Naf + gent or vanco

31
Q

IVDU

Prophylaxis?

A

If prosthetic valve, hx of Endocarditis (EC),
or uncorrected congenital lesion

32
Q

What if you find Strep bovis bacteremia?

A

Colonoscopy

33
Q

Suspect for HIV?

A
  • If a patient “travels a lot for work”that means they have sex with lots of strangers and are at risk for HIV
  • Acute retroviral syndrome = 2-3 wks s/p exposure but 3wks before seroconversion.  ie, ELISA neg
    • Fever, fatigue, lymphadenopathy, headache, pharyngitis, n/v/d +/- aseptic meningitis
  • A young patient with new/bilateral Bell’s Palsy.
  • A young patient with unexplained thrombocytopenia and fatigue.
  • A young patient with unexplained weight loss >10%
  • A young patient with thrush, Zoster, or Kaposi sarcoma
34
Q

Start HAART when ?

A

CD4 < 350

or

Viral load >55,000 (except preggos get tx >1,000 copies)

35
Q

HAART and GI, leukopenia, macrocytic anemia ?

A

Zidovudine

36
Q

HAART

Pancreatitis, Peripheral Neuropathy?

A

Didanosine

37
Q

HAART

– HS rash, fever, n/v, muscle aches, SOB in 1st 6wks.

D/C and Never USE again

A

Abacavir

38
Q

HAART

Nephrolithiasis and hyperbilirubinemia ?

A

Indinavir

39
Q

HAART

Sleepy, Confused, Psycho

A

Efavirenz

40
Q

HIV Post-exposure prophylaxis ?

A

If stuck w/ known HIV pt

AZT Lamivudine and Nelfinavir for 4wks

41
Q

HIV+ patient with DOE, dry cough, fever, chest pain

Best Test?

A

After CXR

Do Bronchoscopy w/ BAL to visualize bug

42
Q

HIV+ patient with DOE, dry cough, fever, chest pain ?

1st line Treatment?

2nd line Treatment?

Prophylaxis?

A

1st: Trim-sulfa
2nd: Trim-dapsone or Primaquine-Clinda, or Pentamidine

3rd- Atovaquone

4th- Aerosolized Pentamidine (causes pancreatitis!)

43
Q

Tx HIV+ patient with diarrhea

CMV-(<50) ?

A

Tx w/ Gancicylovir (neutropenia) or Foscarnet (renal tox)

44
Q

Tx HIV+ patient with diarrhea

MAC-(<50)?

A

Diarrhea, wasting, fevers, night sweats.

– Tx w/ Clarithromycin and Ethambutol +/- Rifampin

– Prophylax w/ azithromycin weekly

45
Q

Cryptosporidium- (<50) and HIV?

A
  • Transmitted via dog poo, swimming pools
    – Watery diarrhea w/ mucus, Oocysts are acid fast
46
Q

HIV + Neuro + If multiple ring enhancing lesions?

A

Think Toxo.

Do empiric Pyramethamine sulfadiazine (+ folic acid) for 6wks.

If no improvement in 1wk, consider biopsy for CNS lymphoma.

Assoc w/ EBV infxn of B- cells. Tx w/ HAART.

47
Q

HIV + Neuro + If seizurew/dejavu aura and 500 RBCs in CSF?

A

Think HSV encephalitis. (predisposed for temporal lobe).

Give Acyclovir as SOON as suspected.

48
Q

HIV + Neuro + If s/s of meningitis?

A

Think Crypto.

+ India ink.

Tx w/ Ampho B IV for 2wks then Fluconazole maintenance

49
Q

HIV + Neuro + If hemisensory loss, visual impairment, Babinski?

A

Think PML.

(Progressive Multifocal Leukoencephalopaty)

JC polyomavirus demyelinates at grey-white jxn.

Brain bx is gold standard dx

50
Q

HIV + Neuro + If memory problems or gait disturbanc?

A

Think AIDS-Dementia complex.

Check serum, CSF and MRI to r/o treatable causes

51
Q

NEVER do a ____ on a neutropenic patient!

A

NEVER do a DRE on a neutropenic patient!

52
Q

Target rash, fever, VII palsy, meningitis, AV block ?

A

Lyme!

Tx w/ doxy (amox for <8).

Heart or CNS dz needs IV Ceftriaxone

53
Q

Rash @ wrists & ankles (palms & soles), fever and HA.

A

Rickettsia! Tx w/ doxy.

54
Q

Tick bite, no rash, myalgia, fever, HA, ↓plts and WBC, ↑ALT

A

Ehrlichiosis! Can dx w/ morulae intracell inclusion.

Tx w/ doxy

55
Q

Immune suppressed, cavitary lung dz (purulent sputum) + weight loss, fever. Gram + aerobic branching partially acid fast

A

Nocardia!

Tx w/ trim-sulfa

56
Q

Neck or face infection w/ draining yellow material
(+sulfur granules).

Gram + anaerobic branching

A

Actinomyces!

Tx w/ high dose PCN for 6-12wks

Family Medicine: Case Files (21 decks)

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