Acid Fast, Other Org, Spirochetes

Question 1

Non latent primary vs Latent Tb- location dz lung

Answer 1

Non-latent—> lower lobes

Latent Tb–> upper lobe/apical

Question 2

TB meningitis

Answer 2

• common 6mo-4yo
• associated w/ communicating hydrocephalus & SIADH
• CSF protein high

Question 3

TB skin test contraindicated

Answer 3

ONLY if necrotic skin reaction

Question 4

TB test

Answer 4

5mm= HIV+, abnormal CXR, close contact, severely immunocomp
15mm= no risk factors, >=4yo
10mm= the rest

Question 5

Tx with _____ if INH-resistant org or hx INH intolerance

Answer 5

-rifampin 4 months

Question 6

Vit B6

Answer 6

• pt milk/meat deficient diets
• symptomatic HIV
• pregnant adolescents

Question 7

Side effects RX

Answer 7

• INH- monitor S/S liver toxicity if + then lab tests

- Ethambutol- decrease visual acuity w/ decrease color perception 1st sign. Optho exam before then during

Question 8

Nocardia asteroides

Answer 8

• weakly acid fast, beaded, branching & filamentous

- cause thin-walled cavitary lung lesion, brain abscess, neutrophilic chronic meningitis

Question 9

Actinomyces SX, DX, TX

Answer 9

-anaerobic
- SX- dental inf w/ cervicofacial involv, PID ass to IUD, appy & chronic neutrophilic meningitis
DX- smear yellow, sulfur granules
TX- PCN

Question 10

Chlamydia psittaci- SX

Answer 10

• Ass w/ birds

- SX- high fever, myalgias, rigor, pneumonia, splenomegaly

Question 11

C. pneumoniae

Answer 11

• Common >5yo & adolescent

- SX- Community acquired pneumonia w/ bronchospasm

Question 12

C. trachomatis

Answer 12

• SX- trachoma (chronic external eye inf causing catarats), neonatal pneumonia (afebrile w/ staccato cough)

Question 13

Bugs common w/ chronic granulomatous dz

Answer 13

• Staph, Salmonella, Serratia & Aspergillus

Question 14

Bugs common w/ spleen or antibody dysfuntion

Answer 14

H. influenza, S. pneumoniae, meningococci

Question 15

Leptospirosis SX, DX, TX

Answer 15

Ass w/ contact dog/rat urine
SX- myalgias, fever, +/- aseptic meningitis, Weil Sy (hepatitis, renal failure)
DX- Bili disproportionally elevated compared other LFT’s, intial phace + BCX (4-7 days) then +UCX
TX- PCN or Doxy

Question 16

Lyme

Answer 16

Stage I- erythema migrans, myalgias, arthralgias
Stage II- neuro (peripheral neuropathy &/or Bells palsy, lymphocytic meningitis), Card (alternating 1st,2nd,3rd degree block, myocarditis)
Stage III-arthritis
TX- Stage I- Doxy or Amox x 21 days
Stage II- CTX or PCN x 21 days
Stage III- Doxy or Amox x 21 days
No response repeat or give CTX