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Flashcards in ID Deck (182):
0

Risk factors for spontaneous primary peritonitis? (2)
Specific type of bug in one.

Cirrhosis, nephrotic syndrome (encapsulated: pneumococcus - loss of IgG

1

Treatment of spontaneous peritonitis?

3rd gen ceph + aminoglycoside

2

common complication of chronic peritoneal dialysis

Staph epidermis peritonitis

3

common bug in VP shunt infx

staph epi

4

primary cause of occult bacteremia

strep pneumo

5

bug to worry about in asplenic pts

strep pneumo

6

Bugs causing septicemia in neonate

GBS, Ecoli, Strep pneumo, S aureus

7

Bug causing septicemia in infant

GBS, Ecoli, Strep pneumo, Saureus, salmonella

8

bugs causing septicemia in immunocompromised pts

GNR: pseudomonas, Ecoli, klebsiella
Staph

9

Abx for r/o sepsis in neonate

amp/cefotax or amp/gent

10

ecthyma gangenosum: large pustules on indurated inflamed base, think of what dz?

pseudomonas

11

rose spots, what dz?

salmonella typhosa

12

septicemia tx in >3 mo

vanc+CTX

13

prophylaxis for meningococcemia for who and with what?

all persons w/ contact w/ oral secretions, household contacts and close outside contacts
Tx w/ Rifampin q12 x2 days or CTX x1, or Cipro 500 x 1 in >18yo

14

Dx and Tx of DIC in sick kid

Expect low fibrinogen and high fibrin degredation products and high d-dimer.
Tx w/ ABX then clotting factors and platelets

15

what bugs does latex agglutination test for?

When to do this?

BINS: GBS, Influenza/H (HIB), Neisseria Mening, Strep pneumo
Helpful w/ partially treated infx when culture unreliable

16

latex agglutination caveats:
False positives in who?
cross reactivity w/ what?

False pos in children recently received HIB vaccine
Ecoli x-react w/ N. meningitidis.

17

transfusion related infx, esp pna?

CMV

18

pneumocystis jiroveci

PCP (pneumocystis carinii pneumonia)

19

tx for fever, neutropenia

-Zosyn (piperacillin-tazobactam) + aminoglycoside
-Ceftazidime or cefapime

20

water park bug, what does it cause

cryptosporidium (looks like viral gastro but lasts longer)

21

Tx of cryptosporidium or Giardia in child >1 yr w/ diarrhea
Tx if crypto and immunocompromised

Nitazoxanide
IF immunocompromised crypto: oral human IG or bovine colostrum

22

immigration + acute abdominal obstruction

ascaris lumbricoides, tx: albendazole x 1, mebendazole x 3d, ivermectin x1

23

staccato cough

chlamydia pna

24

intracytoplasmic inclusion bodies

chlamydia

25

definitive dx of chlamydial pna?

Ab-specific test or PCR

26

4Cs of chlamydia

Cough, conjunctivitis, chlamydia, cixteen wks

27

lab finding and possible tx for chlamydial pna in newborn

eosinophilia
emycin PO or azithro. Or if needed non-macrolide, sulfonamide

28

s/e of macrolides (azithro, clarithro)

diarrhea, abdominal stuff

29

dx of chlamydial pna in teen?

immunoflourescent Abs

30

most common fatal tick-borne dz in US?
Dx?
Tx?

RMSF
Dx w/ direct IF or skin bx
Tx w/ Doxy RIGHT away

31

rash in RMSF?

mac pap --> petechial,
extr --> trunk

32

season for RMFS?
Tx?

May/June
Doxycycline!

33

Bug in Q fever
what does it cause
what is tx

Coxiella burnetti - inhalation of spore like particles, can be tick bourne
causes PNA
tx w/ doxy or supportive care

34

Bug causing amebiasis

entamoeba histolytica

35

Bug causing severe GI bloody diarrhea, liver and brain abscesses, and lung dz?

Amebic dysetery, entamoeba histolytica

36

hematophagous trophozoites

E. histolytica

37

Tx of amebiasis (E. histolytica)

Flagyl or tinidazole --> luminal amebicide (iodoquinol, paromyin)
Can just do luminal if asx cyst excreter

38

iodoquinol or paromocyin are what?

Luminal amebicide

39

round worm

Toxocariasis

40

eosinophilia, exposure to dog/cats, preschooler eating dirt: Gi and Resp sx

Toxocariasis

41

3 clinical manifestations of toxocariasis?

1. viscera larva migrans: fever, hepatomegaly, wheezing
2. ocular larva migrans: visual disturbance
3. covert toxocariasis: GI sx, pruritis, rash

42

Viscera Larva Migrans in suspected toxocariasis
Dx and Tx?

Dx w/ ELISA and get stool cx to r/o other parasites
Tx w/ mebendazole or thiabendazole

43

(Longhaired cats, Licking dogs/dirt, ____Dz in Lungs and Liver)
What is the dz?
Big clue?

Larval!! (Ls: Toxocariasis)
*hepatomegaly

44

Tx of giardia?

flagyl, furazolidone, albendazole

45

Tx of schisosomal, liver fluke, tapeworm?

Praziquantel

46

tx of strongyloidiasis

thiabendazole
(strong guy doing bends)

47

Bug in cat scratch disease
When to tx
What to tx w/?

bartonella henselae
tx: supportive unless hepatomegaly, large painful LAD, immunocompromise --> azithro, emycin, cipro, Bactrim, Rifampin are all choices

48

bug to cover for in cat bite and tx

staph and Pasteurella multocida
Tx w/ Clinda and Bactrim (for pasteurella)

49

gram negative pleomorphic org in non-immunized child
Tx

HIB, H flu
Tx: CTX

50

3 encapsulated bugs to think about w/ asplenia

1. H flu
2. strep pneumo
3. N. meningitidis

51

when to give HIB prophylaxis?
with what?

if a child <4 incompletely immunized is in house or immunocompromised child in house.
Rifampin!
Trick: no px if non-typeable Hflu

52

dx of pertussis
Tx of pertussis

Dx: culture and IF nasal swabs
Tx: erythromycin estolate, or clarithro/azithro

53

how does pertussis tx help?

1. catarrhal stage: shortens the URI phase
2. during paroxysmal stage: decr period of communicability but doesn't shorten coughing ever

54

how do you handle pertussis prophylaxis

anyone exposed gets erythromycin to prevent spread

55

classic salmonella poisoning: timing and dx

1-2 d after exposure. stool culture

56

who should be treated for salmonella infx? and with what?

< 3 mo infant, risk for invasive dz (malignancy, colitis, immune compromise). Tx w/ amox, bactrim, cefotax, cipro in adult.

57

type of bug causing pna / death in CF?

pseudomonas cepacia

58

ABx for pseudomonas

ceftaz**
gent, tobra, cefepime

59

dairy farm, fevers, myalgias
Dx and Tx

brucellosis, dx w/ Ab testing, tx Doxy, Bactrim + Rifampin
Prolonged tx

60

tx of cdiff

flagyl

61

GBS risk fx?

1. low SES
2. multiple sex partners
3. hx stds, young maternal age
4. ROM >18h
5. fetal scalp monitor/instrument breaking skin

62

indications for GBS prophylaxis in pregnant lady

1. previous infant w/ invasive GBS dz
2. GBS bacteriuria
3. pos GBS screen
4. unknown GBS w/ gestation < 37wk, ROM>18, fever 38

63

descending paralysis in infant

infantile botulism

64

mechanism of botulism

block release of Ach (presynaptic)

65

when to treat newborn w/syphilis?

1. if mom tx in last mo of pregnancy
2. if tx w/ emycin which doesn't cause placenta
3. if baby titers are higher than mothers

66

Whats the deal with newborn syphilis lab results

FTA-ABS are forever high
VDRL should go down

67

macular papular rash, HSM, and peeling skin in newborn
Dx?

Syphilis

68

sniffles, bullous lesions, osteochonditis, HSM in newborn
Dx and Tx

syphilis, PCN

69

white nodules on placenta in sick newborn

listeria (microabscesses)

70

Listeria vs GBS regarding mom in pregancy

ASX during pregnancy: GBS
Flu like: listeria

71

the buzz words for campylobacter fetus

family w/ animal exposure
premature delivery

72

Tx for strep throat in pcn allergy
Why

erythromycin, clindamycin
TO prevent ARF

73

gram negative bacteria from rabbits

tularemia (francisella tularensis)

74

Remembering treatment for Tularemia?

Rabbits: gentle, Gentle-mycin (Gentamicin)

75

Cause of bubonic plague
Sx?
How do you get it

yersinia pestis
sx: buboes: inguinal painful LN, other LAD
from handling dead animals

76

three types of Bubonic plague?

1. sepsis
2. meningeal
3. pneumonic

77

Tx of bubonic plague (Yersinia)

gentamicin / streptamycin
OR doxy,chloramphenicol, tetracycline

78

resistance in hospital acquired MRSA?

multidrug: beta lactamase ABs and cephalosporins. NEED vanc

79

ABx that can be used in community MRSA

bactrim, gent, doxy

80

Causes of systemic candiasis?

YEAST: Widespread immunosuppression, Extensive burns, Abx, Suppressed immunity, TPN use

81

encapsulated yeast causing pulm dz and meningitis

cryptococcus

82

exposure in cryptococcus

bird droppings, pigeons

83

Tx of cryptococcus
if resistant?

amphotericin B + fluconazole
ADD 5FC (flucytosine) for resistant infx

84

tx of Crypto in pt w/ renal dz?

liposomal form of amphotericin B

85

California, Arizona, Texas travel. Think what dz?

Cocciciomycosis

86

sx of coccidiodomycosis?

vague influenza sx, but severe

87

Tx of aspergillosis?

Vorixonazole or amphotericin B

88

Influenza sx + HSM in recent travel to mississippi or missouri, or ohio

Histoplasmosis

89

crypto vs histo?

both bird droppings, but histo gives HSM

90

tx of histo?

supportive unless complicated or immunocompromised, then amphotericin b or fluconazole

91

lymphocutaneous manifestations after gardening. chain of nodules, bone/joint sx, superficial/deep tissues.
Tx.

Sporothrix schenckii: sporotrichosis
Itraconazole

92

Dx of CMV?

Urine culture for CMV w/in first 3-4 wks of life

93

Sx of congenital CMV

5Cs: chorioretinitis, cerebral calcifications (periventricular=center), censorineural hearing loss, urine Culture

94

blueberry muffin baby

congenital CMV

95

Tx of CMV

Gangciclovir

96

Diagnosing arbovirus meningitis

CSF virus specific IgM or 4x elevation of IgG from acute to convalescent

97

type of virus mumps is

paramyxovirus

98

Complications of MUMPS?

meningitis, underwear (orchitis), muscle ache, pancreatitis, swelling of parotid

99

is infertility a complication of Mumps?

very uncommon

100

cause of intermittent parotid swelling?

salivary gland stone

101

HHV-6

Roseola

102

exanthum subitum

HHV-6, Roseola

103

fever then rash

roseola

104

rate of congenital rubella in affected mother during T1?

50%

105

Congenital Rubella sx

cataracts, PDA

106

rubeola

measles

107

when most contagious with measles?

5 days before and after rash

108

timeline of measles

prodrome x 2 days, Koplik spots, rash day 5-10

109

HIV pt w/ exposure to measles (rubeola)

IM immunoglobulin

110

who should get measles IM Immunoglobulin?
What else can you do?

HIV, child < 1 who is exposed within 6 days of exposure! Also immunocompromised and pregnant ladies.
Can also give MMR w/in 3 days of exposure

111

When to revaccinate after MMR or IM immunoglobulin after measles exposure?

if MMR before age 1, need to repeat after 1y birthday
if IM Ig, give MMR 5 mos later

112

5th dz?

parvo B19

113

DX of HIV In newborn

Ab crosses placenta, so need HIV DNA PCR

114

Rx to prevent vertical HIV trm
Rate of trm?

ziduvodine (AZT), nevirapine
Actual rate: 5% developed, or 30-40%

115

HIV buzzword mnemonic?

H: HSM
I: intellectual
V: very poor Abx, frequent bact infx

116

testing and tracking for HIV seroconversion?

6 wks, 3 mos, 6 mos

117

needlestick by HIV person contam vs high risk exposure?

2 drugs for contaminated needlestick for 4 wks
3 drugs for hi risk for 4 wks

118

infant screening for HIV?

birth, 2, 4, 6, mos

119

What is foscarnet for?

CMV retinitis, severe mucocutaneous dz in acyclovir resistant HSV, Zoster in acyclovir resistance

120

HIV, MMR and VAricalla vaccines

YES if not markedly immunosuppressed

121

tx of infant exposed to varicella (time period of risk for newborn?)

VZIG: mother develops it between 5 days before delivery to 2 days after

122

type of precautions for mumps, rubella, pertussis

droplet

123

precautions for aspergillosis, TB, measles, varicella

airborne: need special units

124

most common cause of PNA in school aged child

mycoplasma pna

125

two bugs in cervical adenitis and how to distinguish
tx?

s. aureus: in younger, more indolent, more likely to supporate
GAS in older kids, more acute
Often need surgical drainage

126

treatment of most cases of cat scratch adenitis?

usually self limited, and can observe

127

most common associated sx in Pertussis in 1 mo

pna (25%), 4% get sz

128

Heterophil antibodies are specific to what virus in mono?

EBV, not CMV/Toxo/HIV

129

viral capsid antibody for EBV shows what compared to EBNA (nuclear antigen)

EBNA: old infx
viral capsid Ab: acute infx

130

staph scalded skin, recover organism (which) from where?

Staph aureus from nasopharynx (toxin mediated skin rxn)

131

poor prognosis in meningococcemia (4)

1. hypotn
2. WBC <10,,000
3. petechiae w/in 12 h
4. NO meningitis...

132

erythema multiforme w/ what bug

mycoplasma pneumoniae, HSV

133

koplik spots appear when in measles

after rash

134

brain abscess in neonate bug

citrobacter koseri (diversus)

135

scarlet fever and rheumatic fever mechanisms

scarlet fever: toxin mediated
rheumatic fever: immune complex mediated

136

meningitis after head trauma
?bug

s pneumo

137

Pregnant woman exposed to parvo B19
Recommendation?

-risk to fetus is low, but needs more monitoring.
She's already exposed, so no need to take leave of absence from work

138

Best HIV testing for infant

Viral PCR (DNA)
Viral load (RNA)
Elisa at 18 mos x 2...

139

biggest bacterial infection concern in HIV+ infant
rare things for HIV only (2)

S. pneumo
PCP
Lymphoid interstitial pneumonitis (real bad CXR)

140

When to start Bactrim prophylaxis (3)

<1500 CD4 count, infants born to HIV mom, or child after episode PCP

141

Positive PPD?

>15mm in normal no risk kids >4y, but >10 if younger or chronic dz or incr risk.
The >5 PPD is only for immunocompromise or high suspicion for TB/known exposure

142

diarrhea + seizure?

think shigella (lots of extraintestinal manifestations)

143

Yersinia enterocolitica causes severe infx in who?

mostly a dz of toddlers from ingestions (pork intest) BUT can be very severe in iron overload states: thal or hemolytic anemia
RLQ pain...

144

Suspect what immune issues / lab findings in someone with chronic giardiasis

HIV, IgA def, Hypogammaglobulinemia (low IgG or IgA)

145

How do you dx Giardia?

cysts or trophozoites in stool (3 stools for 95% sens)
IF or enzyme immunoassay less sensitive

146

Treatment of Cryptosporidiosis

Niazoxanide x 3 d
Avoid recreational water: chloride won't kill it!

147

Diarrhea and liver abscess?

THink entamoeba histolytica
"amebic dysentery"

148

bug in human bites? (3)

streptococci, S. aureus, anaerobes like Eikenella

149

Test to look for inducible clinda resistance in MRSA

D-test... clinda resistance common in hospital acq MRSA
If there is a "D" its inducible to clinda, then don't give Clinda
(erythro Resistant but Clinda suscept but inducible... )

150

most common but in osteomyelitis or septic joint?

S. aureus (all ages)

151

osteomyelitis in chronic granulomatous disease? (2 bugs)

Serratia, Aspergillus

152

radiograph of choice for suspected osteo?

MRI

153

Ohio or Mississippi valley // cave bug?
Sx clues
Tx?

Histoplasmosis
hilar adenopathy, 95% asx, may have disseminated in young kids
Tx: amphotericin B with severe dz

154

Southwest US, sanJoaquin, northern Mexico bug
high risk groups
sx
tx

Coccidiomycosis
neonates, pregnancy, immunocompromised, Fillipinos!
Asx common, acute pulm, meningitis (subacute)
AMphotericin / Fluconazole

155

parasite to cause rectal prolapse and dysentery

Trichuris trichuria (whipworm)

156

parasite causing Fe def anemia, edema,

Necator americanus (hookworm)

157

parasite causing wheezing, eos, hypergammaglobulinemia

Toxocara canis (visceral larva migrans) dog ascaris worm. Not in stool

158

parasite causing acute intest obstrx, also eosinophilic pneumonitis

Ascaris lumbricoides, Loeffler's (eos pneumonitis)

159

parasite causing fever, myalgias, periorbital edema, conjunctival hemorrhages
After eating pork

Trichonosis: trichinella spiralis (tissue nematode)

160

dx in child
smear shows intraleukocytic includiosn (morulae)
looks like RMSF but less prominent rash and very anemic and TCP. HypoNa

Tx?

Ehrlichiosis
Tx doxy also

161

What looks like catscratch but has bld cx with gram-neg coccobacillus? Bug?
Transmission?
Where most common?

Tularemia - Francisella tularensis
central states, tick biet most common. Also rabbits.

162

bug that invades skin from contaminated water (farm pond, slaughter house -dog/rodent) through cut in skin or mucus membranes
Tx?

The severe liver disease high mortality form? Tx?

leptospirosis: self limited or doxy, CTX

Weil's disease: PCN G for severe disease

163

what causes rat bite fever?
Tx

Streptobacillus moniliforis
Tx: PCN G or Doxy if allergic

164

Isoniazid s/e

peripheral neuritis esp if B6 def

165

Rifampin s/e

staining of tears / contact lenses

166

Pyraxinamide s/e?

hyperuricemia

167

s/e ethambutol

optic neuritis

168

methicillin, oxacillin, nafcillin s/e

interstitial nephritis

169

s/e of ctx?

biliary sludging (not to use in newborn)

170

skin lesion in sick, neutropenic chemo patient?

pseudomonas: ecthyma gangrenosum

171

pin point red spots rash, fever syndrome with GNR

Salmonella typhi

172

meningitis after head trauma /CSF leak?

Pneumococcus! H flu

173

top bugs in afebrile PNA syndrome in baby 4-12 wks (4)

Chlamydia, u. urealyticum, CMV, viral.

174

shunt infx bug/

COag neg staph, skin orgs

175

travel hx to Africca, fever, anemia, splenomegaly, CNS/Sz

cerebral malaria: plasmodium falciparum

176

chronic sinusitis, bronchiectasis with signet ring, situs inversus

Kartageners

177

painful regional LAD and pna, what bioterrorism

yersinia pestis

178

respiratory distress then shock and wide mediastinum in bioterror

inhalation anthrax

179

papular lesion and cervical LAD in bioterror

tularemia

180

sheet like pseudomembrane looks like epiglottitis, ragged air column

dx and bug

bact tracheitis, S. aureus

181

IgA def incr risk of what infx?

Giardia