ID Flashcards
(182 cards)
0
Q
Treatment of spontaneous peritonitis?
A
3rd gen ceph + aminoglycoside
1
Q
Risk factors for spontaneous primary peritonitis? (2)
Specific type of bug in one.
A
Cirrhosis, nephrotic syndrome (encapsulated: pneumococcus - loss of IgG
2
Q
common complication of chronic peritoneal dialysis
A
Staph epidermis peritonitis
3
Q
common bug in VP shunt infx
A
staph epi
4
Q
primary cause of occult bacteremia
A
strep pneumo
5
Q
bug to worry about in asplenic pts
A
strep pneumo
6
Q
Bugs causing septicemia in neonate
A
GBS, Ecoli, Strep pneumo, S aureus
7
Q
Bug causing septicemia in infant
A
GBS, Ecoli, Strep pneumo, Saureus, salmonella
8
Q
bugs causing septicemia in immunocompromised pts
A
GNR: pseudomonas, Ecoli, klebsiella
Staph
9
Q
Abx for r/o sepsis in neonate
A
amp/cefotax or amp/gent
10
Q
ecthyma gangenosum: large pustules on indurated inflamed base, think of what dz?
A
pseudomonas
11
Q
rose spots, what dz?
A
salmonella typhosa
12
Q
septicemia tx in >3 mo
A
vanc+CTX
13
Q
prophylaxis for meningococcemia for who and with what?
A
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
Q
Dx and Tx of DIC in sick kid
A
Expect low fibrinogen and high fibrin degredation products and high d-dimer.
Tx w/ ABX then clotting factors and platelets
15
Q
what bugs does latex agglutination test for?
When to do this?
A
BINS: GBS, Influenza/H (HIB), Neisseria Mening, Strep pneumo
Helpful w/ partially treated infx when culture unreliable
16
Q
latex agglutination caveats:
False positives in who?
cross reactivity w/ what?
A
False pos in children recently received HIB vaccine
Ecoli x-react w/ N. meningitidis.
17
Q
transfusion related infx, esp pna?
A
CMV
18
Q
pneumocystis jiroveci
A
PCP (pneumocystis carinii pneumonia)
19
Q
tx for fever, neutropenia
A
- Zosyn (piperacillin-tazobactam) + aminoglycoside
- Ceftazidime or cefapime
20
Q
water park bug, what does it cause
A
cryptosporidium (looks like viral gastro but lasts longer)
21
Q
Tx of cryptosporidium or Giardia in child >1 yr w/ diarrhea
Tx if crypto and immunocompromised
A
Nitazoxanide
IF immunocompromised crypto: oral human IG or bovine colostrum
22
Q
immigration + acute abdominal obstruction
A
ascaris lumbricoides, tx: albendazole x 1, mebendazole x 3d, ivermectin x1
23
Q
staccato cough
A
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
