Exam 1 Flashcards
1
Q
cryptococcus diagnosis
A
india ink stain, antigen test
2
Q
fungal pneumonia in immunocompromised patients
A
pneumocystis jirovecii or cryptococcus
3
Q
pneumocystis diagnosis
A
special stains, PCR
4
Q
pneumocystis chest xray
A
diffuse bilateral ground glass opacities
5
Q
when to initiate pneumocystis prophylaxis
A
CD4<200
6
Q
dermatophytes
A
cluster of superficial skin fungi that cause tinea infections
7
Q
dermatophytes colonize ____
A
keratinized stratum corneum
8
Q
how long to take meds for onychomycosis
A
3 months
9
Q
non-dermatophyte cutaneous mold
A
malassezia furfur
10
Q
tinea versicolor causative agent
A
malassezia furfur
11
Q
tinea versicolor diagnosis
A
“spaghetti and meatballs” on KOH prep
12
Q
subcutaneous mold
A
sporotrichosis
13
Q
sporotrichosis causative agent
A
sporothrix schenckii
14
Q
sporotrichosis mechanism
A
found in soil, follows traumatic implantation
15
Q
sporotrichosis presentation
A
chronic, localized skin infection - nodular ulcerated lesions
16
Q
what is associated with “fungus ball” in sinuses
A
rhizopus, mucor
17
Q
where can zygomycosis manifest
A
rhino/facial/cranial, lungs, GI tract
18
Q
complications of zygomycosis
A
emboli, tissue necrosis
19
Q
aspergillus aka
A
black mold
20
Q
aspergillus sites
A
body cavities, ear canal, invasive lung disease
21
Q
dimorphic fungi
A
blastomyces, histoplasma, coccidioides
22
Q
where is blastomyces endemic
A
mississippi and Ohio river valleys, great lakes region
23
Q
extrapulmonary manifestations of blastomyces
A
skin, osteomyelitis, CNS, GU tract
24
Q
where is histoplasma endemic
A
southeastern US, mid-Atlantic states
25
extrapulmonary manifestations of histoplasma
bone marrow, blood, CNS, lymph nodes
26
coccidioides endemic
Southwestern US
27
extrapulmonary manifestations of coccidioides
erythema nodosum/multiforme, meningitis, bone, arthralgia, fatigue, fever, myalgia, headache, night sweats, weight loss
28
culture of coccidioides
white fuzzy growth on blood auger - don't open the plate
29
pulmonary manifestations of coccidioides
chronic cough, dyspnea, hemoptysis, pleuritic chest pain
30
coccidioides aka
valley fever
31
coccidioides diagnosis consideration
TB mimic
32
fungal infection chest x-ray appearance
multiple small nodules
33
fungal infection diagnosis considerations
require selective culture media for 21 days, special stains, special testing
34
special testing for aspergillus
EIA test
35
special testing for endemic mycoses
immunodiffusion
36
immunodiffusion
IgM antibodies to endemic mycoses
37
other special test for fungi
complement fixation
38
non-systemic fungal treatment
Imidazoles
39
imidazoles examples
ketoconazole, miconazole, clotrimazole
40
systemic fungal treatment
triazoles
41
triazoles examples
fluconazole, itraconazole, voriconazole, posaconazole
42
which triazoles are PO only
itraconazole, posaconazole
43
which triazoles are IV/PO
fluconazole, voriconazole
44
which triazoles are for candida
fluconazole
45
which triazoles are for aspergillus
itraconazole, voriconazole
46
which triazoles are for dimorphic fungi
fluconazole
47
what is posaconazole used for
other invasive molds
48
cryptococcus treatment
amphotericin IV plus flucytosine PO
49
yeasts on skin/mouth treatment
nystatin
50
dermatophyte treatments 2nd line
terbinafine topical, griseofulvan PO
51
pneumocystis treatment
PO Bactrim
52
terbinafine tx considerations
monitor LFTs, lengthy course of treatment
53
antifungals are metabolized by ___
liver
54
which antifungal has black box warning for cardiomyopathy
itraconazole
55
how to avoid some amphotericin side effects
premedicate with antihistamines
56
normal skin flora
staph aureus, staph epidermitis, strep pyogenes, p. acnes, candida albicans
57
normal nasopharynx flora
strep pneumonia, h. influenzae, moraxella catarrhalis
58
normal mouth flora
strep viridans, actinomyces, candida albicans
59
normal pharynx flora
strep pyogenes, kingella kingae (peds)
60
normal GI flora
enterobacteriacea (e coli, klebsiella, enterobacter), enterococcus, candida
61
normal vaginal flora
strep agalactiae, actinomyces, gardnerella vaginalis, candida albicans
62
mutualism
both the host and microbe benefit
63
commensalism
one partner of relationship benefits (usually microbe) and the other partner (usually the host) is neither harmed nor benefitted
64
parasitic relationship
the microbe benefits at the expense of the host
65
pathogenic relationship
the microbe causes damage to the host
66
opportunistic pathogens definition
only cause disease in those with a compromised immune defense
67
opportunistic pathogens due to T-cell immune compromise
pneumocystis pneumonia, cytomegalovirus colitis
68
opportunistic pathogen due to patients receiving broad-spectrum abx
c diff colitis
69
opportunistic pathogen in patients with intravenous catheters
staph epidermidis bacteremia
70
frank pathogens definition
always associated with disease
71
examples of frank pathogens
neisseria, shigella, HIV
72
facultative pathogens definition
can be either normal flora or pathogenic
73
majority of organisms that cause disease are ___
facultative
74
examples of facultative pathogens
staph aureus, e coli
75
gram positive are usually what morphology
cocci or bacillus
76
obligate aerobes
mycoplasma tuberculosis, pseudomonas, nocardia, bacillus
77
obligate anaerobes
bacteriodes fragilis, fusobacterium, clostridia, actinomyces, peptostreptococcus
78
gram positive bacteria characteristics
thick peptidoglycan layer that holds the crystal violet stain
79
gram negative bacteria characteristics
thin peptidoglycan layer that decolorizes and then holds the safranin (counterstain)
80
common causes of neonatal meningitis
e coli, group B strep, listeria
81
common causes of infant/toddler meningitis
strep pneumo, neisseria, hib, group B strep, e coli
82
common causes of teen/young adult meningitis
neisseria, strep pneumo
83
common causes of adults >50 meningitis
strep pneumo, neisseria, Hib, group B strep, listeria
84
treatment for neonatal meningitis
ceftriaxone, ampicillin
85
treatment for infant/pediatric meningitis
ceftriaxone, vanc
86
treatment for older adults meningitis
ceftriaxone, vanc, ampicillin
87
bacteria not characterized by gram stain
mycobacteria, nocardia, mycoplasma, chlamydia, rickettsia, treponema
88
why can't mycobacteria/nocardia be characterized by gram stain
mycolic acids and lipids in cell wall don't allow stain to penetrate completely
89
why can't mycoplasma be characterized by gram stain
no cell wall
90
why can't chlamydia/rickettsia be characterized by gram stain
obligate intracellular organisms
91
why can't treponema be characterized by gram stain
too small
92
what mechanisms are used by extracellular bacteria to evade an immune response
formation of biofilms, blockade of opsonization/phagocytosis by binding proteins, production of toxins to escape phagosomes, prevention of phagosome-lysosome fusion, induced uptake by non-phagocytic cells
93
gram negative rods lactose fermenters
e coli, klebsiella enterobacter
94
gram negative rods non-lactose fermenter
pseudomonas, e. coli, proteus, salmonella, shigella
95
gram positive cocci catalase positive
staph aureus, coagulase-negative staph
96
gram positive cocci catalase negative beta hemolytic
strep pyogenes, strep agalactiae
97
gram positive cocci catalase negative alpha/non hemolytic
strep pneumo, strep viridans, enterococcus
98
test for mycobacteria
acid fast
99
test for nocardia
modified acid fast
100
test for chlamydia
PCR
101
test for rickettsia
antibody titer
102
test for treponema
dark-field microscopy
103
bronchitis is usually due to ____
respiratory viruses
104
bronchiolitis pathogen
RSV
105
bronchiolitis diagnosis
rapid antigen or PCR testing of nasopharyngeal swab
106
bronchiolitis risk factors
infants, especially premature, age 6 months or younger. And children with congenital heart or chronic lung disease
107
bronchiolitis recommended therapy
maintain nutrition, hydration, and oxygen saturation over 90%
108
croup pathogen
parainfluenza virus
109
croup ssx
barking cough, stridor, labored/noisy breathing
110
croup prognosis
self-limiting in 3-5 days
111
croup treatment
keep child calm, using humidified or cool air. Signle dexamethasone shot can be given. Racemic epi only given in severe cases.
112
organisms causing acute pneumonia
strep pneumo, haemophilus influenzae, moraxella catarrhalis, legionalla
113
organisms causing atypical pneumonia
mycoplasma pneumoniae, chlamydia pneumoniae, SARS-COVID19, flu A/B, adenovirus, RSV, rhinovirus
114
legionella morphology
gram negative bacilli
115
legionnaires infectivity
doesn't spread person to person, but spreads through mist, usually associated with community outbreaks
116
risk factors for legionnaires
>50, weak immune systems, chronic lung disease, heavy tobacco use
117
legionnaires presentation
may be asymptomatic or cough/fever/chills, SOB, myalgias, headaches, diarrhea
118
most common pathogen for aseptic meningitis
enterovirus
119
3 forms of fungi
yeasts, molds, dimorphic
120
most common yeast species
candida albicans
121
candida albicans diagnosis
budding yeast with pseudohyphae visible on gram stain
122
candida albicans skin infection ssx
deep red itchy rash with satellite lesions
123
"notable yeasts"
candida albicans, cryptococcus, pneumocystis
124
which yeast causes pneumonia and meningitis in immunocompromised patients
cryptococcus
125
cryptococcus yeast characteristics
encapsulated budding yeast visible with india ink stain
126
cutaneous molds
dermatophytes, malassezia furfur
127
types of dermatophytes
trycophytan, microsporum, epidermophytan
128
malassezia furfur causes what conditions
tinea versicolor, seborrheic dermatitis
129
tinea versicolor ssx
hypo or hyperpigmentation of skin
130
what are the invasive molds
rhizopus, mucor, aspergillus
131
causative agents of zygomycosis
rhizopus, mucor
132
which mold causes emboli and necrosis of tissue
zygomycosis
133
where does zygomycosis invade
rhino-facial-cranial area, lungs, GI tract
134
black mold
aspergillus
135
where does aspergillus colonize
body cavities, ear canal, lungs
136
ingestion of aspergillus
can contaminate foods and form toxins
137
side effects of triazoles
GI intolerance, hepatotoxicity due to effects on CYP450, rash, QT prolongation
138
side effects of amphotericin B
rigors, fever, chills, hypoxia, dyspnea, local phlebitis, nephrotoxicity, muscle/joint pain
139
mycoplasma pneumoniae aka
"walking pneumonia"
140
mycoplasma pneumoniae diagnosis consideration
bacterium is very small and cannot be gram stained or grown with traditional cultures - can use cold agglutinin
141
2nd most common cause of CAP
mycoplasma pneumoniae
142
mycoplasma pneumoniae presentation
mild ssx, persistent cough for weeks to months
143
who does mycoplasma pneumoniae usually affect
people under 40 and those in crowded settings
144
mycoplasma pneumoniae transmission
spreads via droplets
145
mycoplasma pneumoniae chest x ray
may be normal
146
mycoplasma pneumoniae treatment
normally self-limiting but may use azithromycin or doxy
147
chlamydia pneumoniae type of bacterium
obligate intracellular
148
chlamydia pneumoniae transmission
respiratory droplets
149
chlamydia pneumoniae ssx
similar to m. pneumoniae mild with gradual onset and prolonged cough of 2-6 weeks
150
chlamydia pneumoniae diagnosis
PCR (usually not performed), CXR may be normal
151
chlamydia pneumoniae treatment
usually self-limiting but may use azithromycin or doxy
152
general ssx of atypical pneumonias
`subacute presentation with milder ssx, moderate sputum production, no consolidation
153
chest x-ray atypical pneumonia
may be normal or may see diffuse interstitial infiltrates
154
atypical pneumonia wbc
moderate elevation
155
nosocomial pneumonia pathogens
MRSA, pseudomonas, enterobacteriaceae (e coli, acinetobacter)
156
aspiration pneumonia pathogens
peptostreptococcus, fusobacterium, klebsiella
157
pathogen associated with secondary bacterial pneumonia after influenza infection
staph aureus
158
pathogens associated with lung abscess and necrotizing pneumonia
oral anaerobes, staph aureus, strep pneumo, klebsiella
159
pathogens associated with chronic pneumonia
nocardia, actinomyces, TB, non-TB mycobacteria, endemic mycoses
160
causes of neonatal pneumonia
group B strep, e.coli
161
causes of pneumonia specific to elderly
gram negative bacilli
162
what does rust-colored sputum suggest
strep pneumo
163
antivirals for pneumonia due to influenza
oseltamivir, zanamivir
164
abx for pneumococcal pneumonia
amoxicillin or augmentin, azithromycin, doxycycline, levofloxacin
165
abx for atypical pneumonia
azithromycin, doxycycline, levofloxacin
166
abx for pneumoncystis pneumonia
trimethoprim/sulfamethoxazole
167
new antiviral for influenza
baloxavir marboxil (Xofluza)
168
when to initiate antivirals for flu
within 48 hours of ssx onset
169
mycobacteria culture considerations
require 4-6 weeks to grow, requires 3 consecutive morning sputum samples - PCR testing is sometimes available
170
mycobacteria characterization
acid-fast bacilli
171
when does primary TB infection occur
after inhalation of bacilli
172
CXR latent TB
can be normal, can see granulomas/cavitary lesions
173
are patients contagious with latent TB
no, as long as ssx are not present
174
what is latent TB
bacteria live in the body without making Pt sick
175
latent TB sputum culture
will be negative
176
how to diagnose latent TB
tuberculin test or IFN-gamma release assay
177
what percept of latent TB will become active
5-10%
178
active TB ssx
gradual onset of fever, weight loss, fatigue, hemoptysis
179
active TB transmission
airborne
180
active TB complication
inflammatory response can result in necrosis and structural collapse of lung
181
active TB CXR
hilar lymphadenopathy, apical lobes affected
182
when/how to read TB skin test
measure induration (not erythema) at 48-72 hours
183
5 mm is positive TB test for what groups
HIV, close contacts of active TB, organ transplants, abnormal CXR
184
10 mm is positive TB test for what groups
recent arrivals from high-prevalence countries, IV drug users, residents of long-term care facilities, healthcare workers, comorbid conditions (including leukemia/lymphoma), children under 5
185
15 mm is positive TB test for what groups
everyone
186
active TB treatment
rifampin, INH, pyrazinamide, ethambutol
187
rifampin side effects
reddish-orange secretions
188
INH side effects
peripheral neuropathy, fulminant hepatitis
189
how to prevent neuropathy with INH
administer with vitamin B6
190
pyrazinamide side effects
photosensitivity
191
ethambutol side effects
blurred/changed vision, other eye effects
192
latent TB treatment
9 months of INH
193
biofilm treatment principles
remove infected device, surgical debridement, systemic dual abx therapy with one of them being rifampin
194
some infections creating biofilms
endocarditis, osteomyelitis, chronic wounds/infections, bronchitis from CF, periodontal disease, bacterial prostatitis
195
why are bacteria in biofilms more resistant to bacteria
decreased metabolic rate of bacteria, increased expression of drug resistant genes, abx may not penetrate biofilm
196
which organisms account for 80% of infective endocarditis
streptococci (viridans, enterococcus), staphylococci (staph aureus and coagulase negative)
197
vascular phenomena of infective endocarditis
emboli, hemorrhages (splinter, intracranial, conjunctival), painless Janeway lesions
198
immunologic phenomena of infective endocarditis
glomerulonephritis, painful osler nodes, roth spots, rheumatoid factor
199
criteria for infective endocarditis
Duke criteria: 2 major OR 1 major + 3 minor OR 5 minor
200
predisposing conditions for infective endocarditis
dental procedures, IV drug use, prosthetic heart valves, rheumatic heart disease
201
right-sided endocarditis predisposing factor
IV drug use
202
most common organism associated with right-sided endocarditis
staph aureus
203
most commonly affective valve in right-sided endocarditis
tricuspid
204
acuity and vascular involvement for right-sided endocarditis
acute, pulmonary vascular involvement
205
left -sided endocarditis predisposing factors
acquired valvular disease, congenital heart disease
206
most common organisms associated with left-sided endocarditis
strep viridans, staph aureus
207
most commonly affective valve in right-sided endocarditis
mitral
208
acuity and vascular involvement for left-sided endocarditis
acute or subacute, systemic vascular involvement
209
CV physical exam/echo findings for infective endocarditis
new regurgitant murmur, vegetations on valves
210
frequent contaminants of blood cultures
staph epidermidis, bacillus, diphtheroids
211
causes of false positive blood cultures
poor skin antisepsis, poor technique, blood came from central line, only one set collected
212
causes of false negative blood cultures
abx initiated prior to collection, slow-growing organism or one that is difficult to culture, not enough blood
213
organisms that are difficult to culture
legionella, bartonella, coxiella, rickettsia, chlamydia
214
when to collect blood cultures
when fever spikes
215
how much blood to collect for cultures
at least 10 mL per bottle
216
what does a set of blood cultures consist of
bottles for aerobic and anaerobic cultures
217
how to collect blood cultures
2 sets each from different venipuncture sites
218
categories of risk factors for bacteremia
immune dysfunction, disruption of epithelium, obstruction of drainage conduit or abscess
219
causes of immune dysfunction as risk for bacteremia
neutropenia, age, immunosuppressive meds, genetics
220
causes of disruption of epithelium as risk for bacteremia
trauma, surgery, bites, central venous catheters
221
causes of obstruction of drainage conduit/abscess as risk for bacteremia
choledocolithiasis, nephrolithiasis, diverticulitis, hepatic abscess
222
examples of bloodstream infections
primary bacteremia, infective endocarditis, central line associated, bacteremia secondary to focal infections
223
mortality rate for sepsis
14-37%
224
sepsis criteria for inpatient
SOFA acute change of at least 2 points
225
major elements of SOFA criteria
respiration, coagulation, bilirubin, BP, GCS, creatinine
226
sepsis definition
life threatening organ dysfunction caused by a dysregulated host response to infection
227
septic shock definition
sepsis and vasopressor therapy needed to increase MAP to at least 65 and lactate over 2 despite adequate fluid resuscitation
228
indicators of sepsis
temp over 38 or under 36, HR over 90, tachypnea, WBC over 12 or under 4, SBP under 90, lactate over 1
229
what is a hordeolum/stye
impacted eyelash follicle/gland
230
hordeolum/stye pathogen
staph aureus
231
hordeolum/stye treatment
warm compresses (abx drops usually aren't useful)
232
what is a chalazion
impacted gland on the back of the eyelid
233
chalazion pathogen
staph aureus
234
chalazion tx
abx drops
235
most common conjunctivitis etiology
adenovirus
236
when to use abx for conjunctivitis
if no URI ssx and in one eye only
237
bacterial keratitis
corneal abrasion from contacts
238
bacterial keratitis pathogen
MSSA, strep pneumo, pseudomonas
239
herpes keratitis appearance on exam
dendritic lesion
240
herpes keratitis tx
oral or topical acyclovir plus topical steroid drops and emergent specialist referral
241
preseptal cellulitis cause
scratch or peri-ocular skin infection
242
preseptal cellulitis ssx
swollen, erythematous eyelid
243
preseptal cellulitis pathogens
staph aureus or strep pyogenes
244
preseptal cellulitis tx
keflex
245
what is orbital cellulitis
infection in the connective tissue posterior to orbital septum
246
orbital cellulitis cause
contiguous spread from sinus cavity
247
orbital cellulitis ssx
swollen, eryhtematous eyelid plus proptosis, abnormal EOM, double vision, pain with eye movement
248
orbital cellulitis pathogens
strep pneumo, haemophilus, moraxella
249
orbital cellulitis tx
emergent referral for IV abx and drainage of abscess
250
most common pathogen of otitis media
strep pneumo
251
why is otitis media more common in peds
flat position of eustachian tubes
252
otitis media presentation on exam
bulging and eryhtematous tympanic membrane
253
initial treatment of otitis media
amoxicillin or cephalosporin
254
what is serous otitis media
often viral with dull, injected, or possibly retracted tympanic membrane
255
what is mastoiditis
spread of otitis media to mastoid cells of temporal bone
256
causes of otitis externa
pseudomonas, aspergillus
257
swimmers ear pathogen and ssx
pseudomonas, green mucoid discharge
258
otitis externa tx
abx ear drops
259
most common etiology of pharyngitis in adults
adenovirus
260
bacterial etiology of pharyngitis
strep pyogenes (group A strep), arcanobacterium
261
tx of bacterial pharyngitis
penicillin/amoxicillin
262
tonsillitis/peritonsillar abscess ssx
unilateral tonsil enlargement, displaced uvula, drooling, hot potato voice
263
tonsillitis/peritonsillar abscess tx
PCN/amoxicillin, abscess drainage, prednisone
264
epiglottitis ssx
mild stridor, drooling, trouble swallowing - palliation on sitting up or leaning forward
265
epiglottitis imaging
thumb sign on soft tissue neck x-ray
266
epiglottitis tx consideration
evaluate in monitored environment due to airway issues
267
most common pathogen in retropharyngeal abscess
strep pyogenes (group A strep)
268
retropharyngeal abscess presentation
similar to epiglottitis plus trismus
269
retropharyngeal abscess tx
medical emergency: IV abx and surgical drainage
270
what is ludwig's angina
infection of the bilateral submandibular space
271
when is ludwigs angina seen
in HIV patients
272
Ludwigs angina tx
medical emergency - airway management, IV abx and surgical drainage
273
what is parotitis
inflammation/infection of parotid gland that can be viral or bacterial
274
most common viral parotitis
mumps (can also be EBV, HIV)
275
most common bacterial parotitis pathogens
staph aureus, strep viridans, anaerobic oral flora (peptostreptococcus/fusobacterium)
276
what is sialadenitis
infection/inflammation of any salivary gland that is usually bacterial with same organisms causing parotitis
277
what does sialadenitis usually occur
due to salivary gland blockage
278
tx of parotitis and sialadenitis
beta lactamase inhibitor like augmentin or clindamycin. Also need sialogogues to stimulate saliva formation and gentle massage of gland
279
mumps ssx
asymptomatic, swollen/painful salivary glands, fever, HA, fatigue, anorexia
280
mumps tx
2 weeks of symptom relief
281
mumps complications
orchitis, hearing loss, meningitis/enchephalitis
282
mumps diagnosis
viral culture of buccal mucosa, PCR testing
283
methods of spread of organisms to CNS
hematogenous, contiguous, direct inoculation, neuronal
284
most common route for organisms to spread to CNS
hematogenous
285
what organisms transmit to CNS via neuronal route
herpes, rabies
286
differences in CNS infections
blood brain barrier, no lymphatics, little complement: Difficult for infections to get in and difficult to treat them
287
meningitis main ssx
meningismus (headache, nuchal rigidity, photophobia)
288
acute meningitis is usually
bacterial
289
subacute meningitis is usually
viral but may be bacterial
290
chronic meningitis is usually
mycobacterial or fungal
291
main ssx of encephalitis
altered mental status, +/- focal deficits
292
most common causative pathogens of encephalitis are ___
viruses
293
brudzinksi's sign
involuntary flexion of knees and hips following passive flexion of neck while supine
294
kernig's sign
while the thigh is flexed at hip and knee at 90 degree angles, extension of knee is painful
295
diagnosis of meningitis without signs of ICP is via
Lumbar puncture
296
contraindications to LP
increased ICP, focal deficits, significant coagulopathy, lumbar soft tissue infection
297
standard LP tests
cell count with diff, glucose, protein, gram stain, bacterial culture
298
CSF nucleated cells in bacterial meningitis
>1000
299
%PMNs in bacterial meningitis
>50%
300
glucose in bacterial meningitis
<40
301
protein in bacterial meningitis CSF
>200
302
CSF nucleated cells in viral meningitis
<1000
303
%PMNs in viral meningitis
PMNs then lymphocytes
304
glucose in CSF viral meningitis
WNL
305
protein in CSF in viral meningitis
50-100
306
CSF nucleated cells in TB/fungal meningitis
100-500
307
%PMNs in TB/fungal meningitis
PMNs then lymphocytes
308
CSF glucose in TB/fungal meningitis
less than 40
309
protein in fungal meningitis
50-100
310
protein in TB meningitis
>200
311
first-line treatment for pediatric and adult meningitis
ceftriaxone and vancomycin
312
treatment for neonatal meningitis
ceftriaxone and ampicillin
313
treatment for geriatric meningitis
ceftriaxone, vancomycin, ampicillin
314
pathogens in neonatal meningitis
e coli, group B strep, listeria
315
what pathogens for meningitis are common to all age groups (except neonates)
strep pneumo, neisseria
316
what pathogen causes meningococcal meningitis
neisseria meningitidis
317
transmission of meningococcal meningitis
respiratory droplets
318
complications of meningococcal meningitis
neurological deficits, hearing loss, limb loss, sepsis
319
treatment for meningococcal meningitis
IM ceftriaxone +/- rifampin or cipro
320
vaccine for meningococcal meningitis age given
1st dose age 11-12, booster age 16-18
321
prophylaxis for meningococcal meningitis exposures
2 days of ceftriaxone/rifampin or single dose of cipro
322
treatment for strep pneumo meningitis
dexamethasone and then vancomycin plus 3rd generation cephalosporin
323
preventive vaccines for meningitis
Hib, strep pneumo, neisseria
324
when to do droplet precautions after initiation of abx for meningitis
first 24 hours
325
most common cause of aseptic meningitis
enteroviruses
326
most common season for viral meningitis
late summer
327
causes of viral meningitis
varicella zoster, HSV, enteroviruses (coxsackie, echo), CMV
328
treatment for varicella zoster and HSV meningitis
acyclovir
329
treatment for CMV meningitis
gancyclovir
330
treatment for meningitis due to enteroviruses
supportive care
331
what is required for control of HSV infection
cell-mediated immunity
332
encephalitis implies involvement of the ____
brain parenchyma
333
encephalitis ssx
headache, abnormal behavior, seizures, +/- fever/meningismus
334
viral causes of encephalitis
HSV, rabies, arboviruses, West Nile
335
JC virus causes what complication in patients taking monoclonal antibodies
progressive multifocal leukoencephalopathy
336
ssx of brain abscess
fever, headache, focal deficit, vomiting, seizures, mental status changes
337
bacterial causes of brain abscess
mixed anaerobes, staph aureus, nocardia
338
other causes of brain abscesses
toxoplasma, cryptococcoma, tuberculoma
339
methods of pathogen spread to brain to cause brain abscess
hematogenous, contiguous, post-trauma
340
methods of pathogen spread to spinal cord to cause spinal epidural abscess
hematogenous or contiguous
341
what conditions may be associated with spinal epidural abscess
discitis, vertebral osteomyelitis, psoas abscess
342
spinal epidural abscess diagnosis
MRI, needle biopsy for cultures, PPD, fungal serology, etc
343
causative pathogens in spinal epidural abscess
staph aureus, gram negative rods, streps, TB, fungi
344
clinical features of simple cellulitis
poorly demarcated erythema, edema, warmth, tenderness
345
clinical features of erysipelas
well demarcated erythema, edema, warmth, tenderness, spreads through lymphatics
346
clinical features of necrotizing fasciitis
pain out of proportion to exam, edema, skin necrosis, bullae, cutaneous numbness, fever, crepitus
347
clinical features of abscess
erythema, edema, warmth, tenderness, fluctuance
348
clinical features of impetigo
superficial, intra-epidermal vesicles, "honey-crusted"
349
simple cellulitis pathogens
staph aureus, group A strep (pyogenes)
350
erysipelas pathogen
group A strep
351
necrotizing fasciitis pathogens
strep pyogenes, staph aureus, clostridium perfringens, enteric bacteria, polymicrobial
352
fournier's gangrene site pathogens
GU, polymicrobial
353
abscess pathogens
staph aureus, anaerobes (pilonidal abscess)
354
impetigo pathogens
group A strep, staph aureus
355
hot tub folliculitis pathogen
pseudomonas
356
cellulitis is a ___ diagnosis
clinical
357
characteristics of mild SSTI
local symptoms only
358
characteristics of moderate SSTI
<2 signs of systemic infection
359
characteristics of severe SSTI
failed PO abx and/or have systemic signs of infection, and/or immunocompromised, and/or ssx of deeper infection
360
initial treatment for all purulent SSTIs
I&D
361
when to C&S purulent SSTIs
moderate/severe
362
empiric abx for moderate purulent SSTI
TMP/SMX or doxycycline
363
treatment for moderate purulent SSTI MRSA
TMP/SMX
364
treatment for purulent moderate SSTI MSSA
dicloxacillin or cephalexin
365
empiric tx for severe purulent SSTI
Vancomycin or ceftaroline etc
366
treatment for severe purulent SSTI MRSA
vancomycin or ceftaroline etc
367
treatment for severe purulent SSTI MSSA
nafcillin or cefazolin or clindamycin
368
tx for mild nonpurulent SSTI
oral abx: PCN, cephalosporin, clindamycin
369
tx for moderate nonpurulent SSTI
IV PCN, ceftriaxone, clindamycin
370
tx for severe nonpurulent SSTI
emergency surgical consult plus empiric tx of vanc plus pip/taz
371
nonpurulent SSTIs include
necrotizing, cellulitis, erysipelas
372
purulent SSTIs include
furuncle/carbuncle/abscess
373
SSTI staph/strep abx
cephalexin/ceftriaxone
374
SSTI with MSSA
dicloxacillin
375
simple cellulitis abx
doxycycline
376
tx for impetigo
bactroban/mupirocin ointment
377
SSTI with MRSA
bactrim
378
SSTI abx if reactions to other meds
clindamycin
379
severe SSTI abx
pip/taz and vanc (covers pseudomonas)
| PCN+clinda : covers GAS and clostridium for nec fasc
380
most animal bites are from a ___
dog
381
pathogen in human bites
eikenella
382
pathogen in cat bites
pasteurella
383
pathogen in dog bites
capnocytophaga
384
bite wound treatment
copious irrigation with exploration for foreign bodies and bone/tendon involvement, leave open when possible or loosely suture
385
wounds that become infected within 24 hours of bite are often _____
pasteurella
386
first-line bite prophylaxis
augmentin
387
when to initiate tetanus prophylaxis after a bite
if it is has been more than 5 years since last immunized
388
characteristics of nec fasc
rapid spread, brawny edema of site, wooden feeling to tissue, crepitus with worsening perfusion and later anesthesia, sepsis
389
initial empiric treatment for nec fasc
vancomycin and pip/taz
390
defined treatment for nec fasc if due to GAS
penicillin and clinda
391
toxic shock syndrome pathogens
staph aureus, GAS
392
characteristics of toxic shock syndrome
fever, hypotension, ARDS, coagulopathy, sunburn-like rash, renal/liver failure, necrosis
393
toxic shock syndrome initial treatment
IV PCN and clindamycin, surgical debridement, IV immunoglobulin
394
common organisms in hematogenous osteomyelitis
staph aureus, GAS, mycobacterium, staph epidermidis, Hib
395
vertebral organisms in hematogenous osteomyelitis
staph aureus, staph epidermidis, mycobacterium, GNR, candida
396
diagnosis of osteomyelitis
bone biopsy/aspiration, blood cultures, PPD/AFB culture
397
treatment of osteomyelitis
cover for MSSA/GAS and add coverage for MRSA if septic or previous history. Treat with IV abx for minimum 6 weeks
398
organisms in local infection non-hematogenous osteomyelitis
staph aureus, GNR, anaerobes
399
Organisms in puncture wounds becoming non-hematogenous osteomyelitis
staph aureus, GAS, polymicrobial, pseudomonas
400
what pathogen associated with foot puncture wound in diabetic neuropathy
polymicrobial
401
what pathogen associated with puncture through a tennis shoe
pseudomonas
402
septic arthritis usually affects how many joints
one
403
pathogens in septic arthritis
staph aureus, GAS, gonorrhea, salmonella
404
diagnosis of septic arthritis
bacterial culture of joint aspirate, fluid cell cout/diff, glucose, total protein, blood cultures, STI testing
405
post-infectious reactive arthritis presentation
polyarticular in larger joints of lower extremities 4-6 weeks after infection
406
respiratory organisms leading to reactive arthritis
GAS, neisseria meningitides, viruses
407
GU organisms leading to reactive arthritis
gonorrhea, chlamydia
408
GI organisms leading to reactive arthritis
salmonella, shigella, campylobacter, yersinia
409
treatment of reactive arthritis
prednisone
