ID Flashcards
(182 cards)
1
Q
Less common g(+) organisms in neutropenia
A
Corynebacterium P. acnes Bacillus Leuconostoc *some not treated with Vancomycin
2
Q
Are anaerobic infections common in neutropenia?
A
NO
3
Q
What is the danger level for neutropenia?
A
500 cells/mm (granulocytes)
4
Q
Most important exam points in febrile neutropenia
A
upper airway mucosa, teeth, eyes and rectum
5
Q
Initial lab work in febrile neutropenia…also consider?
A
CBC, CMP, hepatic fxn, urine/blood cx
Also consider: Chest imaging if respiratory Sx (CXR if low risk, CT if high risk), LP (if confused), fugal markers bronch or open lung bx, skin bx
6
Q
Choice of empiric therapy for febrile neutropenia in high risk patients (4)? (High risk: pt expected to have ANC 7 days and/or has major CMx or liver/kidney dysfxn)
A
- Mero
- Imipenem
- Cefepime
- Pip-tazo
7
Q
When should you add Vanc or Zyvox to empiric coverage in febrile neutropenia? (6)
A
- Hemodynamic instability or other signs of severe sepsis
- Pneumonia
- Positive blood cultures for gram-positive bacteria while awaiting speciation and susceptibility results
- Suspected central venous catheter (CVC)-related infection
- Skin or soft tissue infection
- Severe mucositis in patients who were receiving prophylaxis with a fluoroquinolone lacking activity against streptococci and in whom ceftazidime is being used as empiric therapy.
8
Q
Which 3 gram positives are NOT covered by Vanc?
A
- Leuconostoc
- Lactobacillus
- Pediococcus
9
Q
Indications for echinocandins (3)?
A
- Invasive candidiasis
- Salvage therapy for disseminated aspergillosis
- Empiric anti-fungal therapy in febrile neutropenia (some cases)
10
Q
Can fluconazole be used as empiric antifungal?
A
NO!
11
Q
Most common inherited immune deficiency
A
selective IgA deficiency
12
Q
recurrent infections for encapsulated organisms recurrent giardiasis food/respiratory allergies associated autoimmune disorders (Hashimoto's, SLE, RA)
A
IgA deficiency
13
Q
3 things to be aware of with selective IgA deficiency
A
- women can have false positive urine pregnancy tests
- higher than normal blood transfusion anaphylaxis rates
- IVIG contraindicated
14
Q
What types of infections are those with acquired humoral deficiencies susceptible to?
A
Recurrent, often severe, upper and lower respiratory tract infections with encapsulated bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae)
Chronic diarrhea
15
Q
What diseases do you get with complement deficiency?
A
C1, C2, C4
- recurrent bacterial infections (think bacteremia, sinopulm infections, and meningitis), esp w/ encapsulated bugs.
- genetic deficiencies have strong assoc w/ later development of SLE
C3
-severe, recurrent infections with encapsulated bacteria, MC Pneumococcus > H. flu
C5-C9
Recurrent Neisseria infections (meningo and gonococcus)
16
Q
Screening test of choice for complement deficiency
A
CH50
17
Q
Most common complement deficiency
A
C2
18
Q
What diseases are T cell deficient people likely to get?
A
Progressive infections with ordinarily “benign” viruses, opportunistic intracellular pathogens, or fungi. Major examples- CMV, EBV, other herpes viruses, mycobacteria, candida, aspergillus, crypto.
19
Q
What are the infections & risk time-periods in post solid organ transplant patient?
A
1 month- donor infections or nosocomial infections
2-6 months - opportunistic infections from immune suppression
>6 months- community acquired infections
20
Q
Which antibiotic binds to RNA polymerase and blocks transcription of DNA to RNA?
A
Rifampin
21
Q
Which antibiotic targets DNA gyrase?
A
Quinolone
22
Q
Which antibiotic affects cell membrane function and acts like a quinolone?
A
Metronidazole
23
Q
Which antibiotics block folic acid?
A
Sulfa and trimethoprim
24
Q
Which antibiotics affect cell wall synthesis?
A
Beta lactams
25
Which antibiotic binds reversably to the 30S subunit
Tetracyclines
26
Which antibiotics bind to to 50S subunit
Macrolides
27
Which antibiotic binds IRREVERSIBLY to the 30S subunit?
Aminoglycosides
28
What is the "rule of thumb" regarding MIC and MBC?
MBC is roughly 8-10x the MIC
29
Which antibiotics exhibit concentration-dependent killing?
Aminoglycosides and quinolones
30
Which antibiotics exhibit concentration-independent killing (time dependent killing)? What is the significance of this?
Beta-lactams
If you miss a dose, you have higher chance of treatment failure
31
In time-dependent killing, how long should a patient's drug concentration be higher than the organism's MIC?
50% of the dosing inteval
32
PCN is still the drug of choice for: (6)
1. Strep agalactiae (GBS) ppx
2. Viridans strep
3. PCN sensitive S. pneumo
4. Syphilis
5. Actinomyces
6. N. meningitidis (if PCN-sensitive)
33
Potential complication of nafcillin and dicloxacillin?
Tubulointerstitial nephritis: fever, eosinophilia and rash
34
Ampicillin is the drug of choice for: (4)
Listeria meningitis
Salmonellosis (if sensitive)
UTI (if susceptible)
Enterococcal infections
35
Uses for 1st Gen Cephalosporins
Skin/Soft tissue infxns
Surgical ppx
Oral treatment of mild UTI
36
Uses for 2nd Gen Cephs (Cefoxitin/Cefotetan)
PID
| Post operative abd infections
37
Facts about 3rd generation cephs
pneumococcal coverage (1st line)
NO staph coverage (better to use 1st gen)
NO anaerobic coverage (better to use 2nd gen)
Ceftazadime is only 3rd generation that covers pseudomonas
3 indicated for Enterobactericacae meningitis: ceftriaxone, cefotetan and ceftazidime
38
What is one clue to ESBL production
selective susceptibility to Cefipime,
| but resistance to all other beta-lactams
39
Best use for aztreonam
Gram neg coverage and pseudomonal coverage in patient with BETA LACTAM ALLERGY
40
Potential complication of imipenem use?
Lower seizure threshold
41
When should you consider using a drug other than Vanc for a staph infection?
If MIC is >1mcg/mL
42
How do you treat Red Man syndrome?
Slow Vanc infusion time or with antihistamines
43
Complications of Linezolid?
Reversible thrombocytopenia, anemia, leukopenia
Sensory neuropathy
Serotonin Syndrome
44
What organ system is Daptomycin ineffective in?
Lungs - interacts with pulmonary surfactant, resulting in
| inhibition of antibacterial activity
45
What are the gaps in coverage for Tigecycline?
Pseudomonas
Proteus
Providencia
46
What two antibiotics exhibit post-antibiotic effect?
Aminoglycosides and Quinolones
47
4 facts about quinolones
1. Vitamins and laxatives reduce absorption
2. Can increase theophylline levels
3. Not for kids or pregnant/lactating patients
4. Not for MRSA, even if susceptible
48
Best quinolone to treat pseudomonas?
Cipro...who knew?
49
Oseltamivir and zanamivir treat which type of Influenza?
Type A and B
50
Major side effects of Ketoconazole
Hepatitis
***Gynecomastia
Decreased libido
51
Candida species that are resistant to Fluconzaole
C. krusei
| C. glabrata
52
For Boards, what is the drug of choice for MRSA infection?
Vancomycin
53
For Boards, should you use Tygacil for MRSA bacteremia coverage?
No (limited data at this time)
54
Fever, diarrhea, hypotension
hypocalcemia
Diffuse sunburn-like rash or erythema
Multisystem organ failure (kidney, liver, GI, ARDS, coags)
TSS
Menstruating female, post surgical (nasal packing, gauze packed wounds).
Tx: Carbapenem or Pcn with beta lactamase inhibitor + clinda;
narrow to clinda+naf if possible.
IVIG might be helpful.
55
One major difference between Staph and Strep pyogenes toxic shock?
Blood cx usually negative with staph,
| but positive with Strep pyogenes
56
Most common cause of catheter related bacteremia?
Staph epi
57
Which states can you see increased infections with encapsulated organsims?
```
(lack of spleen and/or lack of antibodies):
sickle cell
extremities of age
CLL
MM
agammaglobulinemia
also, alcoholics
```
58
3 sx usually found in Strep pharyngitis
Fever
Tender cervical lymphadenopathy
exudative tonsils
59
What organism should you suspect if patient gets endocarditis or sepsis after GU manipulation?
Enterococcus
60
Treatment of choice for "simple" enterococcal infections
PCN G, amp, vanc (if susc)
61
Treatment of choice for suspected enterococcal sepsis or endocarditis
PCN G, amp or vanc+gent (if susc)
62
Treatment of choice for Listeria
PCN or AMP (add gent if severe or meningitis)
63
Sx and treatment of choice for Diphtheria?
LOW fever, hoarseness, sore throat, gray-white membrane.
Erythromycin (2nd choice PCN)
64
Fever, dyspnea, CP
mediastinal widening.
Enlarging, painless ulcer with black eschar surrounded by edema.
Travel to Middle East, AFrica, S America, Asia. Exposure to wool, hides, or animal hair from there.
Inhalational anthrax.
Cutaneous.
To prevent: vaccinate, cipro x 60d.
Tx: IV cipro + 2 additional if severe.
Oral for cutaneous.
65
Severe nausea and vomiting after fried rice? Treatment
B. cereus
| Symptomatic treatment
66
Contaminated meat or gravy?
Clostridium perfringens
67
People with complete complement deficiency are prone to which organism?
Meningococcus
| can't kill intracellular organisms
68
Empiric treatment for suspected meningococcus? What if PCN allergy?
3rd gen cephalosporin + vancomycin (if meningitis)
If PCN allergy, use chloromphenacol
69
Who should prophylaxis for meningococcus be given to OTHER than the patient?
1. People who live in same household
2. Contacts at daycare
3. People exposed to oral secretions
(i. e. intubation..NOT normal clinical encounters)
70
What drugs are best to eradicate carrier state for meningococcus in certain populations?
Rifampin (children and non-pregnant adults)
Quinolones (non-pregnant adults)
Ceftriaxone (pregnant adults, children
71
Which organism should you suspect with nail puncture wounds through tennis shoe?
Pseudomonas
72
Which organism should you suspect with osteo or endocarditis in IV drug users
Pseudomonas
73
Which organsim should you suspect in otitis externa in severe diabetics?
Pseudomonas
74
"Hot tub rash" =
Pseudomonas
75
"Iguanas and lizards" =
Salmonella
76
"Recent travel, fever,
"rose spots" on trunk one week after fever,
leukopenia
Typhoid fever
Salmonella typhi
Quinolone, 3rd gen ceph, amp, TMP/SMX
77
Adenopathy after hunting?
Plague - Yersinia (southwest) or
| Tularemia (AK, OK, MO)
78
Plague dx and treatment?
Aspirate lymph nodes.
Streptomycin (1st line),
Tetracycline or Quinolones (2nd line)
79
What requires charcoal yeast extract to culture?
Legionella
80
Diarrhea, delirium, HA, pneumonia
Legionella.
Tx: Azithro, quinolones.
If severe, add rifampin.
81
```
Unpasteurized milk
culture negative endocarditis
orchitis
thyroiditis
adrenal insufficiency?
```
Treatment?
Brucellosis
Doxycycline + Aminoglycoside x4 weeks -or- Doxy+Rifampin x 4weeks
Cultures may take 6 weeks to grow!
Can also check acute/convalescent titers.
82
Treatment for tularemia?
Streptomycin or gent...Tetracycline if not very ill.
83
Cat scratch fever? Treatment?
Bartonella henslae.
Bacillary angiomatosis in immunocompromised.
Rifampin + (gent or azithro, depending on severity)
84
```
Rash (distal extremities first, becomes petechial)
Fever
headache
arthralgia
tick exposure.
May also present with diarrhea & abd pain.
Hyponatremia,
Increased LFTs
Thrombocytopenia.
Increased D-dimer.
```
RMSF.
SE and S Central US.
Dx clinical, confirm with serology.
Definite dx: do IF staining on biopsy.
Doxy/Tetracycline or Chloramphenicol (if pregnant)
85
Fever in person who works in slaughterhouse or person who births animals?
Q fever
Inhaling aerosols of infected animals
Tx: Doxy if severe, but usu remits spontaneously.
86
```
Pancytopenia
fever (can persist for months)
HA.
tick bite in MO and AR or northeast/upper midwest.
No rash (except 40% of HME).
Morulae in cytoplasm.
```
Ehrlichiosis. "Rocky Mtn. Spotless Fever".
Convalescent seriologic test.
Doxy/tetracycline.
87
Non healing skin ulceration
(strings of lesions along lymphatic channels)
in people working around fish tanks or
diabetic/immunodeficient.
Mycobacterium marninum
| Tx with ethambutol +rifampin
88
Pleural effusion analysis- lymph 1,000-6,000,
low glc,
high protein,
elevated LDH.
M. tuberculosis
89
Cervicofacial "sulfur" granules..."lumpy jaw"
Actinomyces
90
PID in the setting of IUD placement
Actinomyces
91
Myalgias, rigors, high fever.
Exposure to poultry
pneumonia
splenomegaly.
Chlamydia psittaci.
Ddx: Histoplasma also causes pna & splenomegaly,
assoc with bird & bat droppings.
92
Pneumonia after pharyngitis.
| Severe bronchospasm.
Chlamydia pneumonia
93
Painless chancre, regional lymphadenopathy
Primary syphilis
94
Lung cavitary lesion-->chronic neutrophilic meningitis.
Nodular skin lesions.
Aspirate is culture negative.
Nocardia
Note: most chronic meningitis are LYMPHOCYTIC
Tx: high dose TMP/SMX
Amikacin/imipenim if severely ill
95
Nickel and dime lesions on palms and soles,
generalized lymphadenopathy
cutaneous lesions that look like a number of other things.
Secondary syphilis
| Skin lesions "the great imitator"
96
```
Personality changes
Affect reduced
Reflexes abnl
Eyes Argyll-Robertson pupil (miotic, irregular, constricts to accommodation but not light)
Sensation decreased
Intelligence impaired
Slurred Speech.
```
Tertiary syphillis
| "PARESIS"
97
Pt. has +RPR, -MHA-TP for syphilis...Dx?
Early infection or false positive RPR in low risk population, can repeat test in 6 weeks.
98
Pt. has +RPR, +MHA-TP. Dx?
Infection with syphilis
99
Pt. has -RPR, +MHA-TP. Dx?
Long standing untreated tertiary disease, or
| cross reaction with antibodies from Lyme infection
100
If VDLR or RPR is negative in tertiary syphilis, does this mean disease is cured?
NO, non-treponemal tests can be negative in tertiary syph...
| MHA-TP or FTA-ABS would be positive, however.
101
What is treatment for syphillis in pregnant woman with PCN allergy?
Densitization and then treatment with PCN.
102
```
Fever, myalgia, HA
Eventually leading to severe hepatitis
renal failure
hemorrhagic complications.
Also resp failure, myocarditis, rhabdo.
*Conjunctival suffusion.*
Contact with dog or rat urine.
```
Leptospirosis. Tropics (Hawaii).
Dx: serology.
Tx: most self-limited, but doxy and pcn to shorten duration or for severe.
103
How do you diagnose leptospirosis
blood and or CSF clutures within 10d of illness
| After 10d: urine cx and serum anti-leptospira IgM
104
Two disease spready by Ixodes tick in NE
Babesiosis and Lyme disease
105
Tick bite, followed by irregular erythematous rash with clearing center, arthralgia, myalgia, fever, HA
Stage I Lyme disease
| Rash is erythema migrans
106
Weeks after rash and camping, patient develops neuritis (Bell's Palsy) and/or lymphocytic meningitis. Also 2nd degree heart block.
Stage II Lyme
Can be 1st, 2nd or 3rd degree block (usually alternates)
107
Describe stage III Lyme disease
Months to years after stage II
Chronic arthritis
Possibly chronic Neuro sx
108
Patient shows up with erythema migrans, do you check Lyme serology?
NO, just treat
109
Fatigue, arthralgia, muscle ache.
| Check serologies or treat for Lyme disease?
NO on both counts.
Findings non-specific.
If has Erythema Multiforme, then treat as EM IS specific.
110
Treatment for Lyme
Early disease or Bell's Palsy- doxy/amox 10-21 days
Lyme arthritis- doxy/amox 28 days
Cardiac/Neurologic dz:
Ceftriaxone 2gm or PCN G 20 MU x 21 days
111
Risks for candidal infections
Immunosuppressed
Indwelling caths
Uncontrolled DM
112
Can candida in a blood culture represent a contaminant?
NO. Always represents disease, even if pt. is asymptomatic.
113
What exam should a patient with candidemia have?
Dilated eye exam
114
Should you use lipid ampho B or regular ampho B in urinary candidemal infections?
Regular...lipid ampho B does not penetrate kidneys
115
immunosuppressed patient
headache, fever
pulmonary lesions.
Increased opening pressure on LP.
Cryptococcal meningitis.
Most common form of meningitis in AIDS.
Dx: antigen in CSF or culture.
OS can be >200 cm H2O - tx with serial LP.
Tx: Ampho B and flucytosine...then fluconazole
116
```
Southwest US
erythema nodosum or multiforme
arthralgias, flu-like sx.
1-3wks after exposure.
Consider in pts with pulmonary sx + prolonged constitutional sx.
Misdiagnosed as sarcoidosis.
```
Coccidioidomycosis.
117
```
Flu like illness
pulmonary infiltrates
splenomegaly
palate ulcers
Midwest residence.
Consider in complex pulm dz (nodular, cavitary, LAD)
```
Histoplasmosis (immunocompetent)
Sepsis syndrome in immunocompromised patients.
Serum/urine test not helpful
Itraconazole if severe localized disease in immunocompetent.
Ampho B followed by itra in immunocompromised
118
```
Warty lesions with central ulceration
bacterial pneumonia-like syndrome
Arkansas and Wisconsin hunters/loggers
4-6wks after exposure.
(MS, MO, OH river valleys)
```
Blastomycosis
119
Lymphangitis in a gardener.
Sporotrichosis
| Tx: potassium iodide or itraconazole.
120
Black necrotic spot on nose or sinuses in a poorly controlled diabetic
Rhizopus - Zygomycosis
121
Differences between protozoa and helminths
Protozoa replicate in body & do NOT have eos
Helminths do NOT replicate in body & HAVE eos
122
Whole township breaks out into watery diarrhea...what is cause?
Crysptosporidium
123
Raspberries from Guatemala.
Cyclospora- treat with bactrim
124
"banana shaped gametocytes"
Falciparum malaria
**high rate of chloroquine resistance
1 infected RBC per slide (higher than others)
No schizonts (as opposed to others)
125
What should you screen for prior to starting malaria treatment
G-6-PD - if deficient, primaquine can induce hemolytic anemia
126
Months of fever, sweats, myalgias and shaking chills.
Hemoglobinuria.
Severe hemolytic anemia
Jaundice
Renal failure.
Cross-like pattern seen in RBC on peripheral smears. NE US in summer or early fall.
```
Babesia
**aplenic patients have worse disease
"Maltese cross" pattern on RBC
Hemoglobinuria is predominant sign
Tx: quinine and clinda, or atovaquone + azithro.
```
127
Treament for amebiasis
Metronidazole, followed by paromomycin or iodoquinol even if stool doesn't have organisms.
Examine stool or get serology.
Aspirate of liver abscess often shoes no ameba or PMNs.
128
watery, smelly diarrhea and flatulence
| Child in daycare, camper, or immunocompromised person
Giardia
Tx: metronidazole or tinidazole or nitazoxanide.
Albendazole for kids
paromomycin in pregnancy.
129
3rd degree heart block
achalasia or megacolon
South America and Mexico
Chagas disease (Trypanosoma cruzi).
Most common cause of CHF in Brazil.
Tx: antimonials & arsenicals from CDC.
130
Multinucleated giant cells on Tzank smear
Herpes virus or Varicella
131
```
Temporal lobe seizures
(smells burning rubber)
focal neuro signs
altered MS
high CSF protein and RBC
erythema multiforme
```
Herpes encephalitis
132
When should you not treat neurocystercercosis with antiparisitic drug?
When lots of cerebral inflammation.
| Treat with steroids only.
133
LBPx 10 hours,
zoster infection is suspected but no vescicles present.
What is immediate course of treatement.
Nothing...acyclovir has no effect until vesicles are present.
134
What age should people get zoster vaccination
60
135
How is CMV diagnosed
Antibody titers if immunocompetent
| Antigenemia if immunosuppressed
136
Lymphocytosis with >10% atypical lymphocytes. Which antibiotic do you NOT give.
EBV
| Ampicillin-causes rash
137
Cough, corza, conjunctivitis, rash
Koplik spots on buccal mucosa
(white spots with Erythematous base)
Measles
138
Caver presents with acute delirium, hydrophobia and choking
Rabies
**serology is not helpful
Preventative vaccine indicated for animal worker, caver, vet, anyone who works with bats (NOT hunters)
139
AIDS patient or sickle cell patient
red rash on cheeks
acute pancytopenia
Bone marrow bx shows giant pronormoblasts
Parvovirus
"Slapped cheek" appearance
Likely in aplastic crisis
140
Young patient with hemorrhagic pna
thrombocytopenia
increased hematocrit
Hantavirus
| Likely develops ARDS
141
Most common cause of prosthetic valve endocarditis 1 year after surgery
Staph epi
142
Labs that support infective endocarditis
```
Blood cx (3/4 positive at least prior to abx)
ESR/CRP
Thrombocytopenia
Proteinuria/RBC casts
low complement/cryoglobinemia
RPR+
RF (minor)
```
143
Indications for TEE in suspected endocarditis
Prosthetic valve
Suspicion for perivalvular abscess
***negative TEE with native valve has neg predictive valvue of almost 100%
144
Duke criteria diagnosis of endocarditis
2 major
1 major + 3 minor
5 minor
Major
+ blood cx
(typical IE organism, 2cx 12 hrs apart, any cx for Coxiella burnetti, majority of cx + for atypical organism)
Abnormal Echo
Minor
- Predisposing condition (valve dz, IV drug use)
- Fever
- Vascular phenomena
- Immunologic phenomena (osler nodes, roth spots, +RF, acute glomerulonephritis)
- Positive blood cx that does NOT meet major criterion
145
Empiric treatment for meningitis
3rd Gen Ceph + Vanc
| Add ampicillin if neonate or >60 to cover Listeria
146
Additional tests required for aseptic meningitis
VDRL, acid fast,,
| cryptococcal antigen, fungal serology
147
Meningitis sx after raccoon exposure in California. CSF shows eosiniphilia.
Baylisacaris (nematode)
| **no effective tx
148
6th nerve palsy
basilar enhancement on CT scan
CSF negative for bacteria.
TB meningitis
149
Pt. with Bell's palsy, foot drop
| Camping in past several weeks
```
Lyme meningitis
Tx: Ceftriaxone or high dose PCN G
no doxy (due to penetration)
```
150
Empiric tx for brain abscess
PCN (3rd gen ceph if allergic) + metronidazole
| Add vanc to cover staph if penetrating trauma or sugery
151
HAART combos to avoid
d4T+ ZDV ("4 z extra point")
ddC+ddI (CI for contraindication)
INdinavir + SAquinavir (INSAne to use together)
3TC + d4T ("3, 4, out the door!")
152
Sudden F/C, myalgias, arthralgias
followed by an irregular ulcer that may persist for months.
Regional lymphadenopathy that might necrose/suppurate
AR, MO, OK.
Franciscella tularensis - "rabbit fever".
Transmitted by ticks/flies, but can be ingested/inhaled.
Dx: serologic testing.
Tx: Streptomycin or gent. Tetracycline if not severe.
153
Malaria prophylaxis
Chloroquine: 1-2wks before + 4-6wks after.
```
If resistant area: Mefloquine or atovaquone/proguanil.
Resistant areas:
S. America
SE Asia
emerging: E Africa
```
154
GI sx, hepatomegaly
huge splenomegaly
cutaneous dz in traveler
Leishmaniasis - sand flies.
| Tx: Sodium stibogluconate (pentavalent antimony), pentamidine, or ampho B.
155
```
Only helminth that replicates in body.
Tropical regions, southern US.
GI and pulmonary sx
eosinophilia.
Immunosuppressed: abd pain/distention, neuro & pulm sx, shock.
```
Strongyloides - infxn can persist for decades.
Dx: serial stool samples
Tx: Ivermectin or albendazole
156
Fleeting, migratory pulmonary infiltrates, eosinophilia
Visceral larva migrans - Toxocara canis.
| Tx: albendazole or mebendazole.
157
Eosinophilic meningitis in travelers from S. Pacific
Angiostrongylus cantonensis - rat lungworm. Ingestion of snails, vegetables contaminated by snail slime, crabs, shrimp.
158
Eosinophilic meningitis in kid playing in sandbox
Baylisascaris procyonis - roundworm in raccoon droppings
159
Mexican immigrant with new onset seizures
Cysticercosis - pork tapeworm.
Tx: Niclosamide, albendazole, or praziquantel;
steroids first if lots of edema/inflammation.
No tx needed for calcified lesions and no h/o clinical dz.
160
Eating raw fish, biliary obstruction
Clonorchis - Chinese liver fluke.
| Praziquantel x 1 day
161
```
Travelers diarrhea -
2 months later, fever,
lymphadenopathy,
marked eosinophilia.
Cirrhosis with varicose
(not spiders, gyneco, or ascites)
```
Schistosomiasis "Katayama fever")
Dx: eggs in stool or urine
Tx: Praziquantel x 1 day
162
Tetanus booster need?
None if last booster 5 yrs
163
Arthralgias, Abd pain, Weight loss, Diarrhea.
May have severe malabsorption
neuro sx (lymphatic obstruction)
Skin hyperpig in sun-exposed areas.
Foamy macrophages on PAS stain small bowel biopsy, or PCR CSF.
Tropheryma whippelii
gram + actinomycete.
Ceftriaxone or IV PCN x 14d, then 1 year bactrim.
Ddx: lymphoma
164
Ertapenem use?
once daily. One of few beta-lactams with good staph coverage and extended spectrum GNR.
No pseudomonas.
Outpt parenteral tx - diabetic feet, infections of abdomen, pelvis, skin/soft tissue.
165
Drugs that can cause fever
Phenytoin, carbamazepine
Beta lactams, sulfonamides, nitrofurantoin
Allopurinol
166
How is smallpox different from chickenpox?
Smallpox: rash begins 2-3d after fever
(V: same time)
rash begins on face/arms/legs -> chest/distal
(V: trunk -> face/extremities)
rash in same stage
(V: different stages at any time)
167
Fatigue, HA, ST
fever with posterior cervical LAD
splenomegaly
atypical lymphocytosis.
Aseptic meningitis/enceph,
hepatitis,
hemolyic anemia, thrombocytopenia.
EBV - infectious mono.
| Monospot test. If neg, repeat in 2 wks or EBV serology.
168
Criteria for +Tb test
>15mm no risk factors
>10mm: IVDU, recent arrival, high-risk congregate living, lab workers, high risk for active dz, kids 5mm: HIV, recent contact, old Tb on CXR, transplant, >15mg/d prednisone for >4wks.
169
Gradual dyspnea + nonproductive cough, HIV
F/C/NS, weight loss
Tachypnea, crackles
Most common cause of pneumothorax in AIDS
```
Pneumocystis jirovecii Pna - PJP
Dx: Silver stain exam of induced sputum or bronch - cysts
Tx - bactrim for mild-moderate
IV bactrim for mod-severe
Steroids if A-a>35 or PO2
```
170
```
Diplopia
Dysphonia
Dysarthria
Dysphagia
Descending paralysis (starting with face), 12-72hrs after exposure.
```
Botulism.
Wound botulism: debride wound.
Trivalent antitoxin from CDC - only stops, can't reverse progression.
171
Where do you find chloroquine-resistant malaria?
```
Thailand
Myanmar
Cambodia
Vietnam.
For prophylaxis: atovaquone-proguanil, mefloquine, or doxy.
```
172
Osteomyelitis: characteristic organisms in...
-Foot puncture wound through shoe
- sickle cell
- Pseudomonas
| - Salmonella and S. aureus
173
```
Genital ulcers: multiple 1-2mm tender vesicles or erosions
Tender LAD.
If immunocompromised -
+ hepatitis
esophagitis
colitis
chorioretinitis
acute retinal necrosis
tracheobronchitis
pna
```
HSV
174
Genital ulcers: Single 0.5-1cm painless indurated ulcer
| Nontender bilateral inguinal LAD
syphilis
175
Genital ulcers: ragged, purulent, painful ulcers.
| Painful LAD - rapidly get fluctuant and rupture.
Chancroid (H. ducreyi).
Tx: 1 dose IM ceftriaxone or 1g azithro.
Or: 3d cipro or 7d erythro.
176
Single 0.2-1cm genital ulcer
sometimes painful, disappears in 1-3wks.
2-6 wks later: tender unilateral LAD which my suppurate and fistulae
C. trachomatis - Lymphogranuloma venereum (LGV).
| Tx: Doxy or erythro x 21d.
177
HIV: OI prophylaxis
178
```
Encephalitis
chorioretinitis
pneumonitis
focal neurologic syndrome
mono-like sx
AIDS
```
Toxoplasmosis.
IgM and IgG serologic testing.
Sulfadiazine, pyrimethamine, and folic acid.
179
```
Transplant, first month:
-GI perforations and bleeding
= pna and resp failure
- Reactivation of EBV, polyomaviruses, hep B,C
- increased risk of renal graft failure
```
CMV infection
| Prophylaxis: gan, valgan, or high dose acyclovir
180
What lab must be checked weekly for patients treated with Daptomycin?
CK - risk of severe myopathy, hepatotox
181
Definition of febrile neutropenia?
Pt w/ ANC 38.3°C (101.0°F) or a temperature of >38.0°C (100.4°F) sustained for >1 hour
182
Define high vs low risk for febrile neutropenia
Low risk is expected to be neutropenic (
