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1
Q

common cause of pneumonia in neonates (less than 4 weeks)

A
  1. S. agalactiae

2. E. coli

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2
Q

common cause of pneumonia in children (4wks - 18yr) (in order)

A
  1. viruses (RSV)
  2. mycoplasma
  3. C. trachomatis (infants - 3 years)
  4. C. pneumoniae (school-aged children)
    S. pneumoniae
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3
Q

common cause of pneumonia in adults (18-40yr) (in order)

A
  1. mycoplasma
  2. C. pneumoniae
  3. S. pneumoniae
  4. viruses (eg. influenza)
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4
Q

common cause of pneumonia in adults (40-65yr) (in order)

A
  1. S. pneumoniae
  2. H. infuenzae
  3. Anaerobes
  4. viruses
    5, Mycoplasma
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5
Q

common cause of pneumonia in elderly (in order)

A
  1. S. pneumoniae
  2. Influenza virus
  3. Anaerobes
  4. H Influenzae
  5. Gram (-) robs
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6
Q

Carbapenems - toxicity

A
  1. GI distress
  2. skin rash
  3. CNS toxicity (seizurs) at high plasma levels (less risk with meropenem)
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7
Q

progressive disseminated histoplasmosis - how to diagnose

A

urine or serum histoplasma antigen
also pancytopenia
- cultures takes 4-6 wks

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8
Q

progressive dissaminated histoplasmosis - treatment

A

amphotericin B for 1 week –> after clinical improvement –> oral intraconazole for 1 year

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9
Q

Amphotericin B - toxicity

A
  1. fever/chills (shake and bake)
  2. Hypotenesion
  3. nephrotoxicity
  4. arrhythmias
  5. anemia
  6. IV phlebitis
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10
Q

Malaria - treatment for every situation

A
  1. Chloroquine (for sensitive species)
  2. Mefloquine or atovaquone/proquanil (for resistant)
  3. IV quinidine or artesunate (If life threatening) –> test for G6PD
  4. P. vivax/ovale add primaquine for hypnozoite –> test for G6PD
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11
Q

treatment for all protozoal infections (except malaria)

A

Giardiasis –> Metronidazole
amebiasis –> metronidazole, iodoquinol for asymptomatic cyst passers
cryptosporidium –> prevention by filtering city water supplies, nitazoxanide in immunocompetent, no clear treatment for aids
Toxoplasma gondi –> Sulfadiazine+pyrimethamine
Naegleria fowleri –> Amphotericin B
Trypanosoma brucei –> Suramin for blood-borne disease or melarsoprol for CNS penetration
Babesia –> atovaquone + azithromycin
Tripanosoma cruzi –> Benzidazole or nifurtimox
Leishmania donovavi –> amphotericin sodium stibogluconate
trichomonas vaginalis –> Metronidazole for patient and partner (prophylaxis)

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12
Q

Babesia - treatment

A
  • atovaquone + azithromycin

- Quinine + clindamycin (if severe)

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13
Q

malaria prevention

A

travelers new to endemic areas require chemoprophylaxis
atovaquone - proguanil, doxycycline or melfoquine (2 weeks prior to travels, continued during statyy, discont 4 weeks after returning
other measures to protect from mosquitos

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14
Q

Antihelmintihic therapy - drugs

A
  1. Menbendazole
  2. Pyrantel paomate
  3. Ivermectin
  4. Diethylacarbamazine
  5. Praziquantel
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15
Q

neurocysticercosis - presentation and treatment

A 
1. seizures  2. focal neurological deficit 
hydrocephalus 
treatment: 1. seizure/ICH management
2. antiparasaitic: albendazole
3. corticosteroids
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16
Q

Echinococcus granulosus - treatment

A

albendazole
percutaneous therapy (if more than 5 cm or septations)
- if rupture: surgery

17
Q

pediatric septic arthritis - organisms and treatment

A
  • 0-3 momths:staph, agalacte, gram (-) bacilli): antistaphylococcal + GEentamicin or cefotamice
  • older than 33 months: staph, Strep pyogenus, strep pneumoneia: nafcillin, clindamycin, cefazolin or vancom
18
Q

neonatal sepsis - diagnosis / treatment

A

blood, urine, CSF culture

parenteral antibiotic therapy (eg. ampicillin + gentamycin)

19
Q

endocarditis - viridans susceptivle to penicillin - next step

A

treated with IV penicillin G or IV ceftriaxone for 4 wks

never oral in the beginning

20
Q

vaccines for adults with HIV

A
  1. HBV
  2. HAV: chronic liver disease, men sex men, IV drugs
  3. HPV if 11-26
  4. influenza: inactivated, annually
  5. Mening: all
  6. Pneumonioc: PCV13 once, PPSV23 8 ks later, 5 yyears later + at age 65
  7. Tdap as needed and each pregnancy
21
Q

HIV Protease inhibitors - toxicity

A
  1. hyperglycemia
  2. GI tolerance (nausea, vomiting)
  3. Lipodystrophy (Cushing-like syndrome)
  4. Nephropathy (indinavir)
  5. hematuria (indinavir)
  6. inhibit cytochrome P-450 (ritonavir)
22
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - side effects

A
  1. Bone marrow suppression
  2. peripheral neuropathy
  3. lactic acidosis (nucleosides)
  4. anemia (ZDV)
  5. pancreatitis (didanosine)
23
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - toxicity

A
  1. rash
  2. hepatotoxicity
  3. vivid dreams (efavirenz)
  4. CNS sympoms (efavirenz)
  5. contraindicated in pregnancy (Delavirdine and efavirenz)
24
Q

TB - PPD - when is (+) at 5 or more mm

A
  1. HIV (+),
  2. recent contacts of known TB case
  3. Nodular of fibrotic changes on chest x-ray (previous healed TB)
  4. organ transplant or other immune
25
leprosy - diagnosis and treatment
diagnosis: full thickness biopsy of skin lesion treatment: dapsone + rifampin, add clofazimine if sever
26
M. intracellulare-avium - prophylaxis and treatment
prophylaxis: azithromycin, rifabutin treatment: Azithromycin or clarithromycin + ethambutol Can add rifabutin or ciprofroloxacin
27
human monocytic ehrlichiosis - labs
leukopenia + thrombocytopenia | - elevated liver enzymes + LDH
28
high risk wild animals for rabies
1. bat 2. racoon 3. skunk 4. fox 5. coyote
29
low risk wild animals for rabies
1. squirrel 2. chipmunk 3. mouse/rat 4. rabbit
30
vibrio vulnificus - treatment
empiric in those with likely illness as highly fatal | IV ceftriaxone + doxycycline
31
vibrio vulnificus - diagnosis
blood + wound cultures
32
Legionella - clinical clues
- fever (higher than 39) - Bradycardia relative to high fever - neurological symptoms (esp confusion) - GI symptoms (esp diarrhea) - Uneresponsive to beta lactam + aminoglycoside
33
Legionella - Labs
- low Na+ - hepatic dysfunction - hematuria + proteinuria - Sputum gram stain showing many neutrophils, but few or no organisms
34
PCV - recommended vaccines for adults
- if 65 or older: 1 dose of PCV13 followed by PPSV23 at 6-12 months later - 19-64: PPSV23 alone in heart or liver disease, DM, smoker, alcoholic OR both (LIKE OLDER THAN 65) in very high risk: CSF leak, cochlear implants, SCD, aspenia, immne, kidney disease, HIV
35
Hospital acquired pneumonia treatment
vancomycin + tazosin
36
MRSA pneumonia - people?
superinfection in young people with inf infection - rapidly progressive necrotizing pneumonia, often fatal - malitlobular cavitary infiltrates - often causes leukopenia
37
bacterial mengitis empiric therapy in older than 50 ... (common organisms)
S. pneum, N. menig, Listeria | vancom + 3rd gener ceph + Ampicillin
38
bacterial mengitis empiric therapy in immonocompromised ... (common organisms)
S. pneum, N. menig, Listeria, gram (-) robs vancom + Ampicillin + cefepime alternative to cefepime: meropenem or ceftazidime
39
bacterial mengitis empiric therapy in neurosurgery/penetrating skull trauma ... (common organisms)
Gram (-) robs, MRSA, coagulase (-) staph | Vancom + cefepime

Infectious diseases (13 decks)

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