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Flashcards in ID Deck (153):
1

MCC of bacterial meningitis

Strep pneumoniae
H.influenza
N. meningitidis

2

Rx of meningitis

Ceftriaxone + Vancomycin

If elderly, neonate or immunocompromised add ampicillin for listeria.

3

Organism in pylonephritis from blood?

Staph

4

What to do if pylonephritis caused by staph?

Look for focus of infection and culture blood.

5

Hx of travel to South America / Mexico + bloody diarrhea? (Organism)

Entamoeba histolytica colitis

6

Amebic colitis classic

Gradual onset 1-2 weeks
Diarrhea
Watery / bloody diarrhea
Abdominal pain
Fever

7

Rx of influenza + exception

Sx < 48 HR
Oseltamivir

Sx > 48 HR
Symptomatic

Rx required for all patient worsening even if it's > 48 HR.

8

Rx of suspect MRSA in endocritis?

IV vancomycin + gentamicin

9

Influenza like classic

Sudden
Fever + dry painful cough
Similar findings in family/household
Prostration = exhaustion

10

Risk in herpes zoster ophthalmicus?

Corneal infection due to involvement of nasociliary branch of V1

11

Elderly in nursing home with asymptomatic bacteriuria?

No need for Rx

12

Risk ass w/ Strp bovis?

Colon Ca

13

Rx of herpes zoster

High dose acyclovir 800 mg 5xday

14

1st line in otitis media

Amoxicillin

15

Rocky Mountain spotted fever classic

Camper/hiker
Tick
Rash moves centrally
Paralysis

16

Where is Rocky Mountain spotted fever?

Canada: British Columbia + saskatchewan

US: North Carolina + Arkansas + Missouri + Tennessee + Oklahoma

17

Rx of scabies

5% permethrin > lindane

Lindane has neurotoxic SE

18

Why a strep pharyngitis must be Rx?

Prevent rheumatic fever

19

Staph food poisoning

Start 1-6 hr after meal
Resolves 1-2 days

20

Indication of sever or lethal Rocky Mountain spotted fever

High creatinine due to renal failure

21

Predictor of vancomycin efficacy

Trough serum level > 10mg/L to prevent development of bacterial resistance

22

What derm disease associated w/ GAB infection

Guttate psoriasis

23

Center criteria for pharyngitis

Tonsillar exudate
Tender cervical LN
Fever
No cough
If > 2 points Rx w/ Abx
0-2 Rx symptomatic

24

Splenectomy increases risk of what infections?

Encapsulated organisms:
S. pneumoniae
HiB
E. coli
Staph
Salmonella
Klebsiella and

25

Hx of tick bite? Management

Remove parasite w/in 24-48 HR
By: medium tipped angled forceps

26

Trichinosis classic

10-15 days Hx of infection
1st = diarrhea
2nd = sever muscle weakness +/- CNS

27

Dx trichonsis

Muscle biopsy shows trichinella spiralis.

Other:
High CK
High eosinophils
High LDH

28

Dx of pseudomemebrenous colitis

Stop antibiotics
Start metronidazole

29

When to use oral vancomycin in pseudpmembrenous colitis?

Pregnancy / breastfeeding
Allergy to metro
Recurrent not responsive to metro

30

Subacute / atypical pneumonia + EM rash + hemolysis + low Na (organism)

Mycoplasma pneumonia

31

Legionella pneumonia clues

1. Immunocompromised
2. Hotels, water tanks
3. Hepatic involvement
4. Low Na + Low PO4

32

HIV classic

Young
Oral thrush
Ulcerative esophagitis
Weight loss
LN

33

MCC of HIV

Drug use

34

MCC of ulcerative esophagitis in HIV

CMV
HSV

35

Risk of pneumocystic jirovecii pneumonia?

In HIV (CD4 <200)

36

Rx of C. Botulinum

Antitoxin against neurotoxin A,B,C

37

MCC of bacteremia in elderly?

UTI

38

Risk of pneumocystic jirovecii pneumonia?

In HIV (CD4 <200)

39

MCC of c. Botulinum

Home - canned foods

Preservative that reduce oxygen like vacuum packaging

40

Sx of C. Botulinum

Bulbar paresis:
Dysarthria
Dysphonia
Flaccid facial expression

41

Rx of H. Pylori

Triple Rx for 14 days
Amoxicillin
Clarithromycin
Omeprazole

Other:
BMT = bismuth, metro, tetra
LAC = lansoprazole, amoxicillin, clarithromycin

42

Dx C. Diff

C. Diff cytotoxin essay

43

Dengue Fever

3-14 days Hx of travel to tropical area
+/- Hx of mosquito bite
Pro dorm: erythema mottling, facial flushing

Classic Sx:
Sudden fever, chills <10 days.
Sever headache (breakbone)
Maculopapular or petechial rash

44

Anti-TB needs acidic environment

Pyrazinamide
It's inactive at natural PH 7.4
Work on acidic phagosomes of macrophages PH 5 I.e extra cellular TB

45

EBV association

Burkitts lymphoma
Hodgkin's lymphoma
Large B cell lymphoma
Nasopharyngeal carcinoma

46

Rx of TB

8 weeks of:
Rifampin
Isoniazid
Ethambutol
Pyrazinamide

47

Infection from rabbits

Tularemia (Francisella tularensis)

48

Rx of tularemia

Streptomycin

49

Dx osteomyelitis

MRI

50

Leprosy classic

AFB +ve

De pigmentation

Loss of fine touch and pain sensation

Disfigured feature due to cartilage infection and granuloma formation

51

Prophylaxis in HIV+ve?

If CD4
< 200 PCP prophylaxis
< 100 toxoplasmosis
< 50 M. Avium

52

Opportunistic infection prophylaxis in HIV

Aziyhromycin for M. Avium

53

What must be r/o before TB prophylaxis

Active TB

54

HSV encephalitis location

Temporal area

55

Sx of HSV encephalitis

Gustatory hallucinations
Confusion

56

How C. Botulinum causes disease

Works on polysialoganglioside receptor

57

Rx of URTI with strep. Pneumoniae

Erythromycin

58

Most abundant site for HIV replication

GI tract

59

T/F: serum sickness reaction after HBV

T

60

Cause of ehrlichiosis

Lone star tick
Ixodes tick

61

Rx of pertussis

1st line Macrolides
2nd line TMP/SMX

62

Cat scratch disease classic

Few red papules at site of scratch
Painful LN
+/- hepatosplenomegaly

63

Rx of travelers diarrhea

Fluroquinlones 1-3 days

64

What's not a sign of pharyngitis?

Cough

65

What's periodontitis? Rx?

Tooth's roots infection + cellulitis + apical abscess.

Rx: clindamycin, amoxici/clav

66

What's walking pneumonia

Pneumonia doesn't cause patient sever symptoms (patient not confined to bed)

67

Cause of walking pneumonia

M. Pneumoniae

68

+ve PPD in HIV?

> 5 mm

69

What antibiotic not assisted with C. Diff and food for pneumonia

Macrolides

70

Use of chloride in CSF

Dx TB (low in TB)

71

Diarrhea in HIV? MCC

Cryptosporidiosis

72

Prophylaxis against chloroquine-resistant malaria?

Mefloquine

73

Contraindication to mefloquine?

Epilepsy

74

Necrotizing fasciitis

Fever
Pain sever
Tenderness
Edema
Bronzed skin
Poorly controlled DM

75

Necrotizing fasciitis in perineum called?

Fournier gangrene

76

Rx of necrotizing fasciitis

Surgical debridement + IV antibiotics

77

When to biopsy isolated LN?

> 3 cm
Supraclavicular LN
Constitutional Sx
Patient with risk of malignancy

78

Approach non-tender isolated LN

Wait for 4-6 weeks

79

MCC of pneumonia in HIV

P. Jirovecii
P. Carinii

80

Dx IE?

Blood cultures
Transthoracic echo

81

When to go for surgery in IE?

CHF from infection
Abscess
Persistent infection despite RX

82

Antiviral contraindicated in COPD and asthma

Zanamivir

83

Rx of latent TB

Isoniazid mono therapy 9 months.

84

Is rifampin used for LTB in HIV?

No, due to resistance + drug reaction

85

Infection with intermediate host?

Tapewarm (diphyllobothrium latum)

86

Risk factors for necrotizing fasciitis

Age > 50
Atherosclerosis
Burn, trauma, post-op
Cancer
Steroids use
DM
Low albumin
IV drugs + alcoholism

87

Osteomyelitis classic

Localized pain
Constitutional Sx
Erythema
Tenderness

88

Cause of staph diarrhea

Poultry
Sliced meat, pudding, egg

89

Dx cryptosporidium

AF stain of stool

90

In HIV + CNS Sx you sus?

Toxo

91

MCC of acute bacterial diarrhea?

Campylobacter > salmonella > E. coli > shigella

92

MC site of osteomyelitis

Foot

93

If you sus pneumonia what to do next?

CXR to confirm
Rx of hypotension in sepsis

94

Rx of low BP in sepsis

IVF
If fails: vasopressors
Norepinephrine > dopamine

95

Areas of Lyme disease

Ontario
Quebec
New Brunswick
Nova Scotia

96

Dx Lyme disease

ELISA for borrelia burgdorferi

97

Rx Lyme disease

IV ceftriaxone

98

Pain killer contraindicated in sulfa allergy

Celecoxib

99

Timing in chronic vs acute diarrhea

Acute < 15 days
Chronic > 15 days

100

Types of chronic diarrhea

Watery (osmotic or secretory)
Inflammatory
Fatty

101

Giardiasis classic

Malodorous
Greasy stool
WBC < 5/hpf
PH < 5
Use of PPI (low CL)

102

Pneumonia
Adolescent / child
Bilateral lower lobe infiltrates
Cold agglutination (organism?)

Mycoplasma peunomniae

103

Legionella pneumonia classic

Pneumonia
+ GI diarrhea Sx
Water exposure (cruise)
Air conditioner (hotel / business building)

104

Organism in cat scratch disease

G-ve
Bartonella Hensela

105

Rx of cat scratch disease

Supportive

106

MCC of skin infection in DM (Rx or not Rx)

- Previously Rx: polymicrobial

- Never Rx: staph + strept.

107

Hx / FHx of hemochromatosis
Lymphangitis
GI Sx (diarrhea, RLQ)

Yersinosis

108

Causes of enlarged mesenteic LN?

E. Coli

If Hx hemochromatosis = yersinia

109

Cause of mucormycosis?

Fungus Rhizopus
Mucor
Absidia

110

Rx of mucormycosis

Debridement
IV amphotricin B

111

Toxic sock syndrome.

Fever
Low BP
Erythema and diffuse macular rash involving palms + soles.

112

Rx of lung abscess

Clindamycin

113

Instructions to infectious mono patients

Stop contact sports until exam is normal and spleen is regressed to its normal size.

114

MCC of diarrhea on cruise

Norwalk virus

115

Rx of asymptomatic bacteriuria in pregnant

Nitrofurantoin

116

MOA of nitrofurantoin

Reduce bacterial flavoprotein = inactivate and alter bacterial ribosomal proteins.

117

Best way to determine stage of HCV?

Liver biopsy

118

HIV + pneumonia + encephalitis + retinitis?
(Organism)

CMV

119

Dx Pneumocystis jirovecii

HIV
Patchy infiltrate on CXR

120

Rx of pneumocystis jirovecii

IV TMP/SMX

121

Complications of otitis media?

Cholesteatoma
Meningitis
Tympanic membrane rupture
Conductive hearing loss

122

a 24hr virus causes diarrhea?

Norovirus / Norwalk virus

123

MCC of non bloody diarrhea

Campylobacter

124

Hantavirus infection classic drug

2 syndromes:

- HFRS:
Fever, headache, back pain
Petechial rash
Renal failure (hematuria + proteinuria)
Rx: IV ribavirin


- HPS:
Deer mouse
Fever, maylagia, resp Sx, GI Sx
Pulmonary edema
Rx: supportive (ribavirin not effective)

125

Where to expect hantavirus

Colorado
Arizona
Rural areas

126

2ry syphilis rash

Rash on trunk, palms and soles
With patch hair loss

127

Stain for 2ry syphilis

Warthin-Starry silver stain is

128

Rx of CAP (Rx or never Rx)

1. Never Rx:
Macrolides esp. azithromycin

2. On Abx last 3 months:
Flouroquinolone

129

What electrolyte imbalance not seen in TSS?

High Ca

130

Organisms could cause lung abscess

Pseudomonas
Klebsiella
Staph
Strept. Pneumoniae
Nocardia

In HIV: PCP

131

Which serum protein is low in sepsis?

Albumin
Transferrin

132

High proteins in sepsis?

Complement
Haptoglobin
Fibrin split
CRP
Ferritin

133

Nursing home acquired pneumonia Rx

Cover G-ve
Levofloxacin

134

Types of typhus?

Endemic
Epidemic

135

Other name from r endemic typhus?

Murine typhus

136

Transmission of epi vs endemic typhus

Endemic: rat or cat flea

Epidemic: body lice (louse infestation) + rarely flying squirrels

137

Location of endemic vs epidemic typhus

Endemic: southwest US (New Mexico)

Epidemic: Continent of South America

138

Sx of epi vs endemic

Both fever, chills, headache + rash

Endemic: maculopapular rash

Epidemic: 1st: small pink macule then erythematous maculopapular rash.

139

Dx epi vs endemic typhus

Biopsy rash

140

Rx of epi vs endemic typhus

Doxycycline 200 mg day 1 then 100 mg BID for 7 days

141

Prevention of epidemic typhus?

Louse control

142

What's Brill-Zinsser disease?

Recurrent for of epidemic typhus

143

Epi/endemic typhus vs typhoid (Sx)

All: fever, headache, pains, rash, cough

Epi: maculopapular rash + low BP

Endemic: erythematous maculopapular rash moves peripherally + hacking cough.

Typhoid: rose colored patches on trunk + worsening cough + green "pea-soup" stool

144

Where to get Vibrio Vulnificus?

Raw oyster
Shellfish

145

Who's at risk of vibrio vulnificus

Alcoholics
CKD
Liver disease

146

Classic vibrio vulnificus?

Watery diarrhea = hypotension
Fever / chills
Rash (bullous)

147

Dx vibrio vulnificus

Blood/stool culture

148

Rx of vibrio vulnificus

Cipro
Or
Doxy

+
IVF

149

Organism in histoplasmosis

Histoplasma capsulatum

150

Classic histoplasmosis

Wooded areas;
- Ohio, Mississippi, penn, NY, Maine

1. Associated with birds / bats litters (farmer, cave, woods)

2. Fever, dry cough, B Sx

3. Erythema nodosum

151

Dx histoplasmosis

- CXR = mass + LN

- Tissue biopsy

- C/S of blood, sputum, urine

- Ag testing > culture!

152

Rx of histoplasmosis

Mild: itraconazole

Sever: amphotricin B

153

Epi/endemic typhus vs typhoid (organism)

Epidemic: R. Prowazekii

Endemic: R. Typhi

Typhoid: salmonella typhi/paratyphi