7) Infectious Disease (Part 1) Flashcards
(53 cards)
1
Q
Bacterial meningitis diagnosis
A
- Lumbar Puncture
- Head CT first if evidence of increase intracranial pressure
2
Q
Bacterial meningitis first-line antibiotic choice
A
- IV Ceftriaxone or Cefotaxamine + Vancomycin
- Add Ampicillin (if over 50 years old to cover for Listeria)
- Plus dexamethasone (to prevent deafness)
3
Q
Encephalitis diagnosis
A
- Head CT
- PCR of CSF for HSV
4
Q
Encephalitis first-line antibiotic choice
A
- IV acyclovir (foscarnet if acyclovir resistant herpes)
5
Q
Otitis externa diagnosis
A
- Clinical
- External canal erythema/inflammation
- Tragal or auricle tenderness with palpation
6
Q
Otitis externa first-line antibiotic choice
A
- Drops ofloxacin or ciprofloxacin
7
Q
Otitis media diagnosis
A
- Clinical
- Bulging &/or reduced mobility of the tympanic membrane
8
Q
Otitis media first-line antibiotic choice
A
- Anoxicillin-clavulanate or amoxicillin
9
Q
Acute bacterial sinusitis diagnosis
A
- Clinical (no improvement in 7 days)
10
Q
Acute bacterial sinusitis firs-line antibiotic choice
A
- PO Amoxicillin or amoxicillin-clavulanate
11
Q
Streptococcal pharyngitis diagnosis
A
- Positive rapid strep
- Culture (gram + cocci in pairs)
12
Q
Streptococcal pharyngitis first-line antibiotic choice
A
- PO Penicillin V or Amoxicillin
13
Q
Types of UTIs
A
- Uncomplicated cystitis
- Pyelonephritis
- Acute prostatitis
- Acute epididymitis
14
Q
Uncomplicated cystitis diagnosis
A
- UA, Urine culture
- Voiding symptoms, but usually afebrile
15
Q
Uncomplicated cystitis first-line antibiotic choice
A
- PO Nitrofurantoin (macrocrystals)
- Trimethoprim-sulfamethoxazole
- fosfomycin (Monurol)
16
Q
Pyelonephritis diagnosis
A
- UA, Urine culture
- Voiding symptoms, febrile, flank pain and tenderness
17
Q
Pyelonephritis first-line antibiotic choice
A
- IV Ampicillin + gentamicin
- PO Ciprofloxacin
- PO Levofloxacin
- PO Trimethoprim-sulfamethoxazole
18
Q
Acute prostatitis diagnosis
A
- UA, Urine culture
- Perineal or suprapubic pain; exquisite tenderness on rectal exam
19
Q
Acute prostatitis first-line antibiotic choice
A
- IV Ampicillin + gentamicin
- PO Ciprofloxacin
- PO Levofloxacin
- PO Trimethoprim-sulfamethoxazole
20
Q
Acute epididymitis diagnosis
A
- Fever, voiding symptoms
- Painful enlargement of epididymis
- Scrotal ultrasound
21
Q
Acute epididymitis first-line antibiotic choice
A
- Sexually transmitted: IM Ceftriaxone + PO Doxycyclin
- Non-Sexually transmitted: PO Ciprofloxacin, Levofloxacin, or Trimethoprim-sulfamethoxazole
22
Q
Sexually transmitted infections
A
- Trichomonas vaginalis
- Gonorrhea
- Chlamydia
- Syphilis
- Herpes simplex virus
- Lymphogranuloma venereum
23
Q
Trichomonas vaginalis diagnosis
A
- Wet mount with motile trichomonads; pH >4.5
- Affirm VP III DNA probe test
24
Q
Trichomonas vaginalis first-line antibiotic choice
A
- PO Metronidazole or Tinidazole
25
Gonorrhea diagnosis
- NAAT for Neisseria gonorrhoeae (gram – diplococci)
26
Gonorrhea first-line antibiotic choice
- IM ceftriaxone
27
Chlamydia diagnosis
- Nucleic acid amplification test (NAAT) for Chlamydia trachomatis (gram – coccoid or rod shape)
28
Chlamydia first-line antibiotic choice
- PO Azithromycin or Doxycycline
29
Syphilis diagnosis
- Rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) + confirmatory test such as fluorescent treponemal antibody absorption (FTA-ABS)
30
Syphilis first-line antibiotic choice
- IM benzathine penicillin G
31
Herpes simplex virus diagnosis
- Viral culture
| - PCR for HSV
32
Herpes simplex virus first-line antibiotic choice
- PO Acyclovir, valacyclovir, or famciclovir
33
Lymphogranuloma venereum diagnosis
- Inguinal lyphademopathy, “groove sign”
34
Lymphogranuloma venereum first-choice antibiotics
- PO doxycycline
35
Relevant pathogens in the oral flora of the animal
- Pasteurella spp
- Capnocytophaga spp
- Bartonella henselae
- Anaerobes
36
Preemptive early antimicrobial therapy for 3–5 days is recommended for patients with animal bites who are
- Immunocompromised
- Asplenic
- Advanced liver disease
- Preexisting or resultant edema of the affected area
- Moderate to severe injuries (especially to the hand or face)
- Injuries that may have penetrated the periosteum or joint capsule
37
First-line prophylactic antibiotic dose for animal bites
- Amoxicillin/clavulanate (Augmentin), 875/125 mg every 12 hours x 3-7 days
38
Second line antibiotic doses for animal bites
- Clindamycin, 300 mg 3 times per day plus ciprofloxacin (Cipro), 500 mg twice per day
- Doxycycline, 100 mg twice per day
- Penicillin VK, 500 mg 4 times per day plus dicloxacillin, 500 mg 4 times per day
- A fluoroquinolone; trimethoprim/sulfamethoxazole, 160/800 mg twice per day; or cefuroxime axetil (Ceftin), 500 mg twice per day plus metronidazole (Flagyl), 250 to 500 mg 4 times per day, or clindamycin, 300 mg 3 times per day
39
Prophylaxis for puncture wound through intact shoe
- Cover s. aureus and P. aeruginosa
40
Prophylaxis for puncture wound that wasn't through shoe
- Cover gram-positive bacteria
41
Clostridium tetani prevention in young children (DTaP)
- 2, 4, and 6 months
- 15 through 18 months
- 4 through 6 years
42
Clostridium tetani prevention in preteens (Tdap)
- 11 through 12 years
43
Clostridium tetani prevention in adults (Td or Tdap)
- Every 10 years
44
Infection versus bacteremia
- Infection = invasion of normally sterile tissue by organisms resulting in infectious pathology
- Bacteremia = presence of viable bacteria in the blood
45
qSOFA (Sepsis related organ failure assessment)
- Altered mental status (Glasgow Coma Score <15)
- Respiratory rate ≥22
- Systolic BP ≤100
46
Sepsis
- Life threatening organ dysfunction caused by a dysregulated host response to infection
- Infection + Organ dysfunction
(2 or more points in the SOFA score)
47
Septic shock (all 3)
- Clinical criteria for sepsis
- Requires vasopressors to maintain a mean arterial pressure >65mm Hg
- Lactate level >18mg/dL
48
Multiple organ dysfunction syndrome
- Severe end of the severity illness spectrum in sepsis
49
Evaluating multiple organ dysfunction syndrome
- Respiratory – PaO2/FiO2 ratio
- Hematology – platelet count
- Liver – serum bilirubin
- Renal – Serum creatinine (or urine output)
- Brain – Glasgow coma score
- Cardiovascular – Hypotension and vasopressor requirement
50
Management principles in sepsis and septic shock (within 45 minutes)
- Airway, correct hypoxemia, IV access, broad spectrum antibiotics (after cultures)
- Basic Labs including: lactate, ABG, Cultures (blood, sputum, urine, stool, wound, etc)
51
Management principles in sepsis and septic shock (within the first hour)
- IV crystalloid fluids (normal saline or Ringer’s lactate)
| - If hypotensive despite fluids: norepinephrine
52
Fever of unknown origin
- Fever higher than 38.3C (100.9F) on several occasions
- Duration of fever for at least 3 weeks
- Uncertain diagnosis after 1 week of study in the hospital
53
Fever of unknown origin etiologies
- Infections (eg, abscess, osteomyelitis, endocarditis, syphilis, tuberculosis, rheumatic fever)
- Malignancy (eg, hepatocellular carcinoma, leukemia, renal cell carcinoma, lymphoma)
- Systemic rheumatic diseases (eg, Giant cell arteritis, polyarteritis nodosa, rheumatoid arthritis, lupus)
- Others (eg, drug fever, thyroiditis)
