Dx - screen w/ tuberculin skin test (≥15 mm, ≥10 mm if high-risk, ≥5 mm if HIV+ or CXR+) - confirm w/ CXR (cavitation in upper lobe)

ID Flashcards by Alex Maxted

4 main types of lung/respiratory infections

PNA
Lung abcess
TB
Influenze

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Bugs cause
typical CAP
atypical CAP
HCAP

typical CAP = Strep pneumo (#1), H. influenzae (#2), aerobic GNR

atypical: Mycoplasma (#1), Chlamydia, Legionella

HCAP: Staph aureus (#1), Pseudomonas, aerobic GNR

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PNA × alcoholics, bug?

klebsiella

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PNA + immigrant, bug?

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PNA + nursing home, bug?

HCAP (Staph aureus (#1), Pseudomonas, aerobic GNR)

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PNA + AIDS, bug?

Pneumocystis carinii (PCP), TB

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complications of PNA

pleural effusions, empyema, acute respiratory failure

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presentation of typical PNA vs atypical PNA

Typical CAP: sudden-onset fever/chills, productive cough, pleuritic chest pain

Atypical CAP: insidious-onset sore throat, headache, nonproductive cough, dyspnea

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Special Dx test when suspect…
TB…
legionella
HIV

suspect TB → acid-fast stain
suspect Legionella → urinary ag
HIV+ → silver stain (fungi, PCP)

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When do you admit a person with PNA?

2/5 of CURB-65 – 
Confusion
Uremia,
RR ≥30, 
BP <90/60
age ≥65

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outpateint tx of PNA vs inpt tx of PNA

outpatient → Tx azithromycin (<60 y/o), ceftriaxone (≥60 y/o)

inpatient → Tx azithromycin + either ceftriaxone or fluoroquinolone

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who gets pneumovax?

> /= 65

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aspiration → cough w/ foul-smelling sputum, SOB, fever/chills

how to make Dx?
tx?

lung abcess

Dx CXR (cavitation w/ air-fluid levels, most commonly in right lower lobe)

Tx IV abx

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what bugs cause lung abcess?

oral anaerobes (Prevotella, Peptostreptococcus, Fusobacterium, Bacteroides)

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1/1 vs 2/2 TB smx

1° TB: granulomatous inflammation in lower lobes → infx contained → usually asx

2° TB: reactivation in upper lobes → fever/chills, night sweats, weight loss, cough w/ hemoptysis

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how to dx TB?

Dx
- screen w/ tuberculin skin test (≥15 mm, ≥10 mm if high-risk, ≥5 mm if HIV+ or CXR+)

confirm w/ CXR (cavitation in upper lobe)

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Treatment for active vs latent TB

active TB →
2 mos of RIPES (rifampin, INH, pyrazinamide, ethambutol, streptomyin then
4 mos of INH + rifampin

latent TB → INH only

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tamiflu is

oseltamivir

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triad of fever, nuchal rigidity, ∆MS

tx? tx?

Dx head CT to check for ↑ICP, then lumbar puncture + CSF analysis

Tx IV abx

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Kerning sing vs brudzinski sing

Kerning sign: inability to fully extend knees when lying supine w/ hips flexed

Brudzinski sign: flexion of head causes flexion of hips/knees when lying supine

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meningitis, purpura fulminans, bilateral adrenal hemorrhage (W-F syndrome) =

disseminated miningococcal infx

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bugs that cause..

Meningitis × neonates:
Meningitis × kids:
Meningitis × adults:
Meningitis × elderly:

Meningitis × neonates: GBS > E. coli > Listeria

Meningitis × kids: MC > Strep pneumo > H. influenzae

Meningitis × adults: Strep pneumo > MC > H. influenzae

Meningitis × elderly: Strep pneumo > MC > Listeria

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∆MS, focal neuro sx, s/sx of meningitis

dx?
tx?

encephalitis

*meningitis = triad of fever, nuchal rigidity, ∆MS

Dx head CT to check for ↑ICP, then lumbar puncture + CSF PCR

Tx admit + ACV (for HSV), GCV (for CMV)

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bugs that cause encephalitis

viruses: HSV-1 in temporal lobe, arbovirus, enterovirus
toxoplasmosis
aspergillosis

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headache, ∆MS, seizures, nausea/vomiting, focal neuro sx dx? tx?

brain abcess Dx head CT or MRI Tx IV abx, surgical drainage, ±steroids

bugs that cause brain abcesses

Staph, Strep, anaerobes

Abscess × AIDS: bugs? | Abscess × DKA: bugs?

Abscess × AIDS: toxo, fungi | Abscess × DKA: zygomycosis

Tx for pyelo

uncomplicated → Tx Bactrim or Cipro complicated → Tx admit + IV amp/gent

fever/chills, dysuria, frequency, urgency, low back pain + boggy, tender prostate dx? tx?

Dx DRE (boggy tender prostate) + UA/UCx Tx Bactrim or Cipro ** Chronic prostatitis: usually asx Dx prostatic secretion analysis (↑WBC) and Tx long-term Cipro

usually asx, jaundice, dark-colored urine, RUQ pain, n/v, daycare, travel bug? ow to dx? tx?

HAV Dx HAV IgM = acute infx HAV IgG = previous infx or immunity Tx supportive care

jaundice, dark-colored urine, RUQ pain, n/v, polyarteritis nodosa, MGN tx?

HBV Tx IFN-α

Dx HBsAg = ? Dx HBsAb = ? Dx HBeAg = ? Dx HBcAb IgM = ?

Dx HBsAg = acute/chronic infx Dx HBsAb = previous infx or immunity Dx HBeAg = infectivity Dx HBcAb IgM = window period

jaundice, dark-colored urine, RUQ Cryoglobulinemia, Chronic infx, Cirrhosis, Carcinoma, Carriers, IVDA, MPGN Dx? Tx?

HCV Dx HCV RNA Tx IFN-α + ribavarin, liver txp if severe

jaundice, dark-colored urine, RUQ, Deadly, HBV co-infection dx? tx?

HDV Dx HDV Ab Tx IFN-α

jaundice, dark-colored urine, RUQ, cruise ships, fatal in pregnancy dx? tx?

HEV * Dx HEV Ab * Tx supportive care

viral hep strains that are 1. sexually transmitted 2. parentally transmitted 3. fecal oral route

sex: B and D parental: B, C, D fecal-oral: A and E

symmetric, descending flaccid paralysis + canned food or wound infx

C botulism

how to dx and tx botulism

Dx toxin assay | Tx admit + antitoxin

``` Diarrhea × n/v: viral Diarrhea × fever/blood: Diarrhea × mayonnaise: Diarrhea × raw chicken: Diarrhea × raw seafood: Diarrhea × abx: Diarrhea × travel: Diarrhea × daycare: Diarrhea × AIDS: ```

Diarrhea × n/v: viral gastroenteritis or food poisoning Diarrhea × fever/blood: Shigella, Salmonella, Campy, EHEC Diarrhea × mayonnaise: Staph aureus (

Tx for bacterial gastroenteritis

Tx ciprofloxacin x5 days C. diff → Tx Flagyl or PO vancomycin

Cellulitis × fight bite:

Eikenella

tx for cellulitis

Tx Keflex or Bactrim, consult ophtho if orbital involvement

“fiery red”, painful skin lesion on face or extremities Dx? bug? tx?

Erysipelas Strep pyogenes Tx w. PCN or erythromycin

bugs that caise nec fasc

strep pyogeneis and C perfringens tx id debriedment + broad specturm abx

infx of LN → tender LN w/ local cellulitis bug? dx? tx?

lymphadenitis skin forlar/strp pyogenes, staph aureus Tx Keflex or Bactrim, warm compresses

trismus (lockjaw), opisthotonos (spastic back), risus sardonicus (spastic smile) bug? pathophys? tx?

Tetanus c. tetani exotoxin = blocks GABA and glycine relase tx: Tx tetanus antitoxin (TIG) in one site, Td immunization in a different site

``` OM × IV catheter: OM × prosthetic joint: OM × diabetic foot: OM × nosocomial: OM × IVDA: OM × sickle cell: OM × vertebra: OM × cat/dog bite: ```

OM × IV catheter: Staph aureus OM × prosthetic joint: coagneg Staph epidermidis OM × diabetic foot: polymicrobial OM × nosocomial: Pseudomonas OM × IVDA: Pseudomonas OM × sickle cell: Salmonella OM × vertebra: TB (Pott dz) OM × cat/dog bite: Pasturella multocida

how to monitor for resolution of osteomyelitis

serial ESR/CRP

Arthritis × sexually-active young adults: Arthritis × IVDA: Arthritis × sickle cell:

Arthritis × sexually-active young adults: N. gonorrhoeae Arthritis × IVDA: Pseudomonas Arthritis × sickle cell: Salmonella

erythema chronicum migrans

target shaped lesion in lyme dz

how to dx lyme dz

Dx screen w/ ELISA, confirm w/ WB Tx doxycycline

triad of HA + fever + rash (vasculitis that starts on extremities and comes inward) tx?

RMSF doxy

cyclic fever/chills, headache, anemia, splenomegaly how to dx? tx?

blood smear w/ giemsa stain cholorquine (mefloquine if resistent) +/- primaquine for p. vivax/ovale hypnozoites

pain at bite location → fever, malaise → agitation, photophobia, hydrophobia (foaming) → paralysis, coma → death how to dx? tx?

Dx viral cx, Negri bodies on Purkinje cell bx Tx emergent passive + active immunization

Plasmodium falciparum (24h), P. vivax and ovale (48h), P. malariae (72h) via

malaria

vector for malaria

Anopheles mosquito

vector for RMSF

tick

vector for lymes disease

ixodes tick

Rickettsia rickettsii

RMDF

pseudohyphae

candidia

air-crescent sign on CXR | + hemoptysis

aspergillosis

tx for... | aspergilloma vs invasive aspergillosis

lung lobectomy (aspergilloma) IV ampho B (invasiveaspergillosis)

need what to get aspergilloma

prior lung caviation

meningitis/encephalitis in HIV+ pts

cryptococcus

vector for crytococcus

via pigeon droppings

vector for histo

bat/bird droppings in caves

how does histo present? tx?

usually asx, mild respiratory virus itraconazole

tx for cryptococcis

IV amp B + flucytosine

inflammatory lung dz, granulomatous nodules in skin and bone tx?

Blastomycosis itraconazole

gardener local ulcer + ascending LN-opathy tx?

Sporotrichosis (“rose gardener disease”) itraconazole or potassium iodide

usually asx, mild respiratory sx after earthquakes in SW US tx?

Coccidioidomycosis itraconazole

- huge spherule w/ endospores - Broad Based Buds - macrophage-filled spores - India ink stain (thick capsules) - cigar-shaped yeasts

huge spherule w/ endospores = Coccidioidomycosis Broad Based Buds = Blastomycosis macrophage-filled spores = Histoplasmosis India ink stain (thick capsules) = Cryptococcosis cigar-shaped yeasts = Sporotrichosis

bloating, flatulence, foul-smelling fatty diarrhea? bug? dx? tx?

Giardia lambii • Dx stool sample • Tx metronidazole

flask-shaped ulcers in ascending colon → bloody diarrhea; “anchovy paste” abscess in liver → RUQ pain bug? dx? tx?

Entamoeba histolytica * Dx stool sample * Tx metronidazole (for diarrhea and abscess)

usually asx, can cause bowel obstruction bug? dx? tx?

Ascaris lumbricoides • Dx stool sample • Tx mebendazole

mild diarrhea, severe diarrhea in HIV+ pts bug? dx? tx?

Cryptosporidium parvum • Dx acid-fast stain • (no tx exists

hooks onto bowel walls and sucks blood → iron-deficiency anemia bug? dx? tx?

Ancylostoma duodenale (old), Necator americanus (new) • Dx stool sample • Tx mebendazole

perianal pruritus, worse at night bug? dx? tx?

Enterobius vermicularis scotch tape test mebendazole

usually asx `→ macrocytic anemia bug?

``` Taenia saginata (beef), Taenia solium (pork), Diphyllobothrium latum (fish) ``` eats vitamin B12 → macrocytic anemia stool sample praziquantel

cause fibrosis of liver and spleen bug? tx?

Schistosomiasis = S. mansoni/japonicum praziquantel

causes bladder infx → dysuria, bladder SCC

Schistosomiasis = S. haematobium

bugs that cause catheter related sepsis (when left in > __ days)

> 3 days Staph aureus (#1), coag-neg Staph epidermidis (#2)

fever/chills, sore throat, malaise, myalgias, severe cervical LN-opathy dx? tx?

mono EBV, CMV monospot test (heterophile agglutination) test supportive care + avoid contact sports to prevent splenic rupture

ID Flashcards

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