ID Flashcards
(153 cards)
1
Q
Who is at highest risk for osteomyelitis?
A
IV drug users
sickle cell pts
immunosuppressed
2
Q
when do you give rabies PEP after animal bite?
A
High risk wild animal (bat, raccoon, skunk): start PEP unless animal is available, then euthanize and examine brain
Low risk wild (squirrel, chipmunk, rabbit, mouse): No PEP
Pet: If available for testing, observe for 10 days and don’t start PEP unless you see signs. If not available start PEP
3
Q
CSF findings in bacterial meningitis (OP, wbc, protein, glu)
A
Increased Openining Pressure
Increased wbc
Increased Protein
Decreased Glucose
4
Q
Tx for bacterial meningitis
A
Ceftriaxone, Vanc, and Dexamethasone
if >50 or immunocomp, Add Ampicillin (listeria)
5
Q
Causes of diarrhea in AIDS patients
A
CD4:
<200: Cryptosporidium (+ low fever)
<100: Microsporidium (no fever)
<50: MAC (+ high fever) or CMV (bloody + abd. pain)
6
Q
Intrahepatic cysts with exposure = living with dogs for several years
A
Hydatid cysts caused by Echinococcus granulosus (a tapeworm)
7
Q
Febrile wasting disorder in HIV pt with pulmonary (crackles/cough), mucocutanous (nodules/ulcers), and reticuloendothelial (hepatosplenomegaly, lymphadenopathy) + Panycytopenia and elevated transaminases
A
Histoplasmosis
- ->Urine/Serum Histo Ag test
- ->Itraconazole/Amphotericin B
8
Q
What causes cystericosis and how does it present?
A
Taenia Solium tapeworm. Affects the brain (seizures) or cerebral ventricular system (intracranial HTN). Usually no liver involvement (vs echinococcus hydatid cyst)
9
Q
Cardiac manifestations of endocarditis
A
New murmur…usually Mitral Regurg with MVP
10
Q
T/F: Aspiration pneumonia and TB both infect the upper lobes
A
False. Aspiration = lower lobes. TB = apices/upper lobes
11
Q
Dx test of choice for vertebral osteomyelitis (exquisite tenderness to touch over lumbar vertebrate typically)
A
MRI (not bone scan)
12
Q
tx for endocarditis in IV drug user
A
assume MRSA/strep/enterococci
–>Give Vancomycin as first line
13
Q
What do you do when someone steps on a rusty nail?
A
A. If received the 3 childhood toxoid vaccines: only give Tdap if haven’t received booster in last 5 years
B. Didn’t get all 3 in childhood/vaccine status unknown: Tdap + Tetanus IG
Also give TIG for symptomatic tetanus
14
Q
When do you give Tetanus Immunoglobulin but not Tdap vaccine?
A
Never.
15
Q
Kaposi sarcoma vs bacillary angiomatosis
A
Bacillary: ass. with fevers and systemic sxs, may involve mucosa/visceral organs. friable plaques and papules
Kaposi: begin as papules and morph into plaques, have color change, seen on legs/face/mouth/GI
16
Q
Who gets HAV vaccine?
A
- Chronic liver dz (Hep B/Hep C)
- IV drug users
- MSM
17
Q
T/F: You start PEP for HIV exposure if serology of affected person comes back positive i.e. following needlestick
A
False. Get serology but start 3 drug tx right away
18
Q
Empiric antibiotics if you suspect meningitis (while waiting for LP)
A
Cephalosporin + Vancomycin. If immunocompromised/>50, add Ampicillin
19
Q
Myalgia, fever, headache, rigors after tx of Syphilis with IM Penicillin
A
Jarisch-Heixmer rxn. occurs w/in 12 hours tx, resolves within 48 hours on its own.
20
Q
In organ transplant patients, what do you give for prophylaxis against opportunistic infections?
A
Bactrim: covers PCP.
Can also worry about CMV (Ganciclovir)
21
Q
Sxs of Parvo virus infection in adults
A
- typically asx
- most commonly in people with close contact with children (school teachers etc)
- get an acute onset Rheumatoid-like arthritis
22
Q
Bloody diarrhea, RUQ pain, liver abscess, travel to mexico
A
Entamoeba Histolytica….tx with oral metronidazole
23
Q
In a patient positive for Neisseria Gonnorrhea, what co-infections should be tested for?
A
- Chlamydia trachomatis
- HIV
- Syphilis
- Hep B
24
Q
Strep bovis infection
A
Endocarditis and Colon Cancer. Get colonsocopy
25
Does negative heterophile test r/o mono?
Nope, it can usually be negative in early infection. Don't be a peasant!
26
Rash after amoxicillin
EBV
27
Someone comes in with Influenza infection i.e. the flu. Mgmt?
If <65 and without major risk factors (chronic medical problems/pregnancy): No dx'ic studies necessary, just do symptomatic tx
Only give Oseltamavir if >65/risk factors or those w/o risk factors who present within 48 hours of onset
28
Post-influenza bacterial pneumonia
>65: MSSA
| Young adults: MRSA
29
Human bite wound empiric AB's
usually polymicrobial infection of strep/staph/eikenella/h flu/anaerobics
-->Give Amoxicillin/Clavulanate (augmentin)
30
What reduces risk of Toxoplasmosis infection?
Bactrim
31
which pneumococcal vaccine do you give to liver dz patients ?
23 now, and then 13 + 23 when >65
32
Tx of mucormycosis (DM pt with nasal congestion/necrosis)
Surgical debridgement + Amphotericin
33
What is trichinosis and how does it present?
Intestinal roundworm from undercooked meat (usually mexico/china/thailand)
Fever, vomiting, nausea, periorbital edema, myalgia.
Tx with Bendazoles
34
Who gets Pneumococcal 13 vs 23
13, then 23 for >65
13, then 23 for <65 with high risk conditions: CSF leak, SICKLE CELL, Asplenia, Chronic Renal Failure, cochlear impalnts
23 alone for <65 with chronic conditions: DIABETES, SMOKING, Alcoholic, Liver dz, Heart dz, Lung dz
35
Td vs Tdap for adults
All adults should get a one time Tdap dose, followed by Td q10 years. If their vaccination hx is unknown, hit em with the Tdap
36
When do you give Prednisone with bactrim for PCP?
PaO2 <70 or A-a >35
37
Tx of Legionella
Fluoroquinolone or Macrolide
38
T/F: All patients, regardless of hx or sxs, should get one-time HIV screening between ages 15-65
True.
| HIV p24 antigen and antibody testing
39
Who gets annual HIV screening?
IVDU + sex partners
| MSM
40
How does Babesiosis present and who gets it?
Fever + Hemolytic anemia
increased risk = Splenectomy/Asplenia, immunocompromised
Ixodes tick in northeast US
Dx with blood smear (maltese cross), Tx = Atovaquone + Azithromycin
41
Unvaccinated health care worker exposed to Hep B patients blood. Mgmt?
Give Hep B Vaccine
| Give HB IG
42
Tx for chronic hep b/c
Chronic HBV: IFN-alpha, alternatively lamivudine (nucleoside analog)
Chronic HCV: IFN-alpha + Ribavirin
43
T/F: + Anti-HCV = vaccination
False, = HCV infection.
| -->There is no vaccine
44
Neuropathy + CSF findings of Elevated protein but normal cell count/glucose
GBS
45
Tx for GBS
IVIG or PLEX.
Don't give steroids.
46
HIV patient with bloody diarrhea
Probs CMV colitis...need colonoscopy. If +, need ocular exam also to r/o retinitis.
47
How do you make the dx of HCV?
Need 2 steps:
1. + serologic test for Anti-HCV
2. + molecular test for HCV RNA
-->need these 2 before anti-viral agents
48
Infectious esophagitis in HIV
If +oral thrush or dysphagia: Candida
none of these, +odynophagia: CMV
dysphagia = DIFFICULT swallowing
odynophagia = PAINFUL swallowing
49
Prophylaxis against MAC (fever/night sweats/diarrhea/abdominal pain/weight loss) in HIV CD4<50
Azithromycin
50
Pt with uncomplicated pyelo tx
2 days IV ceftriaxone
| If better, DC with oral AB (what theyre sensitive too...even including Bactrim)
51
T/F: C-section is always indicated if mom is HIV+
False. If viral load is low (<1000 copies) and CD4>500, not needed.
52
Sxs of Toxo in HIV pt
Sxs of mass lesion + encephalitis (HA, Fever, AMS, Focal deficits)
53
Meningitis in HIV
Crypto
54
Who gets toxo encephalitis?
HIV
55
Tx for bacterial meningitis
Ceftriaxone + Vancomycin + Dexamethasone. If immunocompromised or >50, + Ampicillin (Listeria)
56
Who else gets PCP other than HIV?
Chronic steroids (think autoimmune dz like SLE)
57
Tx for PCP
Bactrim. Dapsone. Atovaquone. Pentamadine. all are options. Start at front.
58
Immunosuppressed (steroids) or compromised (HIV) patient with cough, hypoxia, SOB, and increased LDH
PCP has increased LDH!
59
organisms implicated in ventilator-associated pneumonia
Nocosomial (HCAP) so Pseudomonas (also, E coli and Klebsiella are other G-), MRSA (also Strep). Need lower resp tract sampling/gram stain and culture. about 48 hours after intubation
60
Who gets mycoplasma pneumoniae (headache, malaise, persistent cough, CXR bad like pleural effusion. can have pharyngitis and rash)
Young healthy patients!!! <30 usually
| -->especially military recruits/prison/dorm
61
What clues make you think Legionella pneumonia?
GI SYMPTOMS!!! also systemic (headache/confusion). Slow onset cough and high grade fever
62
CXR reveals increased interstitial markings. In a patient with cough and fever, what does this indicate?
Interstitial Pneumonia (as in NOT LOBAR CONSOLIDATION NOT STREP). I.e. atypical pneumonia
63
Pneumonia in a person with recent viral illness
Staph aureus.
If <65, MRSA = necrotizing pneumonia (multilobar cavity infiltrates, high fever, hemoptysis...so don't get fucked up and pick TB for post-viral pneumonia in a young patient)
64
Anesthetic, hypopigmented lesions (no sensation on rash) with painful nerves and glove/stocking loss of sensation/neuropathy. Dx: Full thickness bx of skin lesion. Tx with Dapsone and Rifampin
Leprosy
65
Who gets diarrhea from C perfringens?
Consumer of undercooked or unrefrigerated food. Brief watery diarrhea, fever and cramps
66
common watery diarrhea that turns bloody
EHEC
67
Bloody diarrhea
Ecoli
Shigella
Campylobacter
68
Tx for early syphillis in patient w/ hx of anaphylaxis to penicillin
ORAL DOXYCYCLINE JIGNESH
69
Tx of syphillis
No allergy:
- Primary/Secondary: IM Pencillin x1
- Latent: IM Pencillin x 3
- Tertiary: IV IV IV IV Penicillin x 14 days
Anaphylaxis:
- Primary/Secondary: Oral Doxycycline x 14 days
- Latent: Oral Doxycyline x 28 days
- Tertiary: Desensitization and then IV Pen. alt = Ceftriaxone 14 days
70
How does disseminated gonoccocal infection present?
Septic arthritis picture. Purulent monoarthritis or triad of tenosynovitis, papules/pustules on body, and asymmetric polyarthralgias
-->blood cultures of NG often negative due to fastidious growth req, need NAAT. do synovial fluid analysis (gram stain still +)
71
T/F: As soon as CD4 count <200, should give HIV patients MMR, zoster and varicella vaccines if they haven't already
False, these are all live vaccines and contraindicated <200
72
who gets HAV vaccine?
Chronic liver dz (including HBV and HCV), Gay men, IVDU
73
Who gets meningococcal vaccine?
Patients 11-18; college student/military recruits; asplenic
74
Vaccines in HIV additional to normal ones
- Hep B unless they have + Anti-HBs
- Strep pneumo with PCV13 followed by 23 valent few months later; again in 5 years; again at age 65
- Varicella
75
T/F: Reactivation TB is common in HIV and substance abuse
true
76
Tx Pulmonary nodules that grow acid fast rods and do not gram stain vs partially acid fast gram positive
No gram stain: TB, RIPE
| G+: Nocardia, Bactrim
77
types of neonatal conjunctivtis
1. Chemical: <24 hrs, mild, needs lubricant
2. Gonococcal: 2-5 days, most severe of the 3. eyelid swelling can lead to blindness. Prophylaxis against with Erythromycin eye drop in first hour of birth. If infected, tx with IM Ceftriaxone. Can be purulent or mucupurelen
3. Chlamydia: 5-14 days: mild. serousanguinous or mucopurulent discharge. PO macrolide if infected.
78
How do you differentiate orbital from preseptal cellulitis?
Orbital hurts, can have vision impairment, and can have eye bulging (proptosis). Very severe complications (vs preseptal is not bad)
79
how to diff measles, varicella and rubella (all maculopapular rashes starting at head and moving down
Varicella: VESICLES (pruritic) = HSV = VESICLES
Measles: Cough/Coryza(rhinitis)/Conjunctiva/Koplik spot
Rubella: desquamating trunk rash, postauricular lymphadenpathy
80
vitamin A reduces morbidity/mortality in this childhood exanthem
Measles
81
Cystic fibrosis and respiratory infection (cause)
<20 years old aka peds: STAPH AUREUS
| >20 years old: Pseudomonas
82
Pertussis tx/post-exposure prophylaxis
Macrolides! must be given to all house-hold contacts regardless of age/immunization status
83
Kid is exposed to another kid that has chickenpox. How do you manage?
If prior infection/vaccine (2 doses): Observe/reassure
No: Immunocompetent = VACCINE ONLY
Immunocompromised (including pregnant) = VZ IG ONLY
84
mastoiditis and facial nerve palsy are potential complications (in kids) of:
AOM
85
Mumps complication
Aseptic meningitis, Orchitis
86
specific sxs that differentiate kawasaki from scarlet fever (both can have lymphadenopathy, changes to buccal mucosa like circumoral pallor/strawberry tongue, rash/fever)
Kawasaki would have bilateral conjunctival injection and/or changes to peripheral extremities. Sandpaper like rash usually used to describe Scarlet fever.
87
what sxs in a patient with pharyngitis of unknown etiology would make you think viral pharyngitis?
cough, rhinorhhea, nasal congestion conjunvtivitis, oral ulcers
88
Kid walks in with sore throat, dysphagia, tonsillar erythema, palatal petechiae, anterior cervical LN, white exudates on tonsils. next step?
```
Rapid Antigen (Strep) Test! If +, its strep throat and you treat with oral penicillin/amoxicillin.
If negative, get a throat culture. If still negative its viral and just supportive tx
```
89
What additional features does adolescent/adult with Rubella have (in addition to maculopapular blanching rash spreading head down)?
Arthralgias/Arthritis!!! Wrist and fingers etc hurt
90
Sensorineural hearing loss, cataracts, PDA
Congenital rubella
91
Measles vs Rubella
Measles: really HIGH fevers >104; lymphadenopathy = cervical. no arthritis
Rubella: more mild fevers; lymph = posterior auricular/suboccipital; adults get arthritis/arthralgais
92
describe the fever in rocky mountain spotted fever
erythematous macular rash starts at wrists/ankles and spreads centrally
93
Tx of cryptococcal meningitis
First: Amphotericin B with Flucytosine
then: Fluconazole
94
HIV patient with meningitis or signs of intracranial process but negative MRI
Cryptococcus
95
what would you expect in HSV encephalitis?
personality changes, FND, seizures...due to temporal lobe involvement
96
T/F: Negative heterophile antibody test i.e. monospot test rules out EBV
False, 25% false negative rate in first week of infection
97
sore throat/malaise/myalgia + lymphocytosis with variant lymphocytes with a large, vacuolated cytoplasm
EBV!! These are "atypical lymphocytes"
98
Atypical lymphocytes =
EBV
99
Clindamycin is effective against (general):
G+ and anaerobes (so not best for broad spectrum coverage)
100
Amoxicillin-clavulanate (Augmentin) is effective against (general)
G+, G-, and beta-lactamase producing anaeraboes, so great for empiric coverage
101
Ixodes tick dz presents with no rash, thrombocytopenia, leukopenia, and elevated LFTs. Dz, Dx, Tx.
Ehrlichosis. Peripheral blood smear: inclusion bodies in wbc (morule). Doxycyline
102
Ixodes tick dz presents with hemolytic anemia, is severe in asplenic patients
Babesiosis. Peripheral blood smear: rings in rbcs. can also do PCR. Atovaquone and Azithromycin.
-->Babes without spleens destroy rbcs because the rings inside Crow AT them.
103
Ixodes tick dz with rash, AV node block, Bells Palsy, late joint involvement. Dz, Dx, Tx
Lyme Dz. Get Serology (IgM, IgG, Elisa, PCR, etc). Doxycyline or Amoxicillin. For Brain or Heart involvemen: IV Ceftriaxone.
104
Tx of Bacillary angiomatosis aka bartonellae henslae
Doxycycline, erythromycin or HAART
105
how does bx differentiate kaposi (HHV8) from Bacillary angiomatosis (bartonellae henslae)
Kaposi: lymphocytes
Bartonella: neutrophils
106
Tx of legionella
Fluoroquinoles (Levofloxacin) or Macrolides
107
Tx for patient with fever, malaise, atypical lymphocytes, no splenomegaly, is homosexual
CMV mononucleosis: self-resolves.
108
Lobar pneumonia, arthralgias, erythema nodosum in a patient traveled to southwest
Coccidioides (only immunosuprressed need keto/fluconazole. self resolves in healthY)
109
inadequate oral hygiene leading to mandibular molar infections and cellulitis of submandibular space
Ludwig angina
110
colitis (bloody/diarrhea, abdominal pain), liver abscess (RUQ pain, fever), ALT and AST = 100, solitary cystic lesion seen on liver. Dx and Tx
```
Entamoeba histolytica (protozoa from travel to endemic areas)
Metronidazole
(note: HAV = vomiting, RUQ pain, jaundice, LFTs 1000)
```
111
What is erysipelas?
Group A Strep infection leading to high fever, lymphadenopathy, and warm, tender erythematous rash with raised sharp borders. typically on face, may involve external ear.
112
HIV patient with CMV. What screening test is necessary?
Ocular exam to r/o CMV retinitis
113
Bloody diarrhea in HIV patient with CD4 <50
CMV!!!! COLITIS!!! not cryptosporidium (severe watery, low fever, CD4<200), Microsporidium (watery, abdominal pain, CD4<100), MAC (watery, high fever, CD4<50)
114
Puncture wounds +/- osteomyelitis bacteria
Staph aureus and Pseudomonas!
115
T/F: Cryptosporidium is only seen in AIDS patients
False, causes mild watery diarrhea in immunocompetent also
116
Hydatid cysts (eggshell calcifcations around cystic hepatic lesion) in a patient with close contact to dogs
Echinococcus granulosis (tapeworm). Tx w/albendazole
117
Ulcer:: LN + Tx
No pain: No Pain
Pain: +/-
No Pain: Pain
-/- Syphillis. Penicillin (or doxy)
+/? H ducreyi. Azithromycin or Cipro
-/+ LGV. Doxycycline
118
T/F: For primary syphillis, may be too early for serology so you have to do Darkfield Microscopy
True
119
What do you use to dx endocarditis (fever + new murmur)?
BLOOD CULTURES + ECHO (transesophageal)
- ->for Acute (staph/strep pneumo): watch until BCx-, start ABx right away. Won't see the rheum sxs yet
- ->for Subacute (bovis/viridans/HACEK): watch until BCx+, then start ABx. Will have rheum sxs
120
HACEK organisms (subacute endocarditis)
```
H flu
Actinobacillus
Cardiobacterium
Eikenella
Kingella
```
121
back bone of endocarditis tx
VANCOMYCIN and GENTAMICIN
- ->if native (normal) valve, just Vanco
- ->mostly going to add CEFTRIAXONE for most people (if >1 yo). For babies, give cefepime instead.
-->Can't use Vanc? Use daptomycin instead
122
Bacterial associations for endocarditis
Staph: Prosthetic valves, IVDU, catheters
Staph Epi: Pros valve, catheter
Strep Viridans: Dentist
Enterococci: UTI (nocosomial)!!!
123
Who needs prophylaxis against endocarditis and what do you use?
Bad valve
(Congenital heart dz, prostethic, hx of endocarditis)
+ Mouth/throat
(having dental proecdure or bronch/bx of airway)
= AMOXICILLIN (ceftaz if pen allergy)
124
What prophy meds do you give HIV patients?
<200: PCP -->BACTRIM BABY
(DAPSONE if cant bactrim. ATOVAQUONE if G6PDef)
<100: Toxo -->Bactrim
<50: MAC -->Azithromycin
125
how is vertical transmission of HIV prevented (med)
Only Zidovudine
126
Pre and post exposure prophy drugs for HIV
Emtricitabine + tenofovir. +/- Realtegravir
127
Opportunistic infxs cd4 <50 and tx
MAC (disseminated). Proph: Azithro. Tx: Clarithromycin + Ethambutol
CMV Retinitis: Valacyclovir, Foscarnet
128
Patient comes in with Fever and HA. What's the broad ddx?
Meningitis (+neck stiffness)
Abscess/Cancer (+FND)
Encephalitis (+confusion)-->HSV!!! WNV (flaccid)
129
Patient comes in with Fever and HA. How do you decide if you need non-con CT before LP?
```
if any of the FAILS +, need non-con CT before LP!
FND
AMS
Immunodeficiency
Lesion
Seizure
```
130
Fever and HA patient, LP is safe to do before non-con CT (- for all FAILS). Management?
Lots of PMNS --> Vancomycin, Ceftriaxone and Steroids
--> add Ampicillin if immunosuppressed
Lymphocytes --> HSV!!!!!will have bloody tap. Acyclovir
Otherwise, look for Crypto, RMSF, Lyme, TB, Syphillis
131
Fever and HA patient, LP not safe (FAILS). Managment
Give antibiotics now and do non-con CT:
- if CT -, do LP
- if CT+ and HIV + --> Tx toxo and rescan in 6 weeks
- if CT-, HIV- -->BIOPSY --> Cancer gets chemo/rad; abscess/infx gets Antiobiotics/drainage
132
HIV patient with mass lesion/fever and HA and FND/ and CD4<200
Toxoplasmosis
| if they have meningitis on the other hand i.e. no FND and instead neck stiffness, its Crypto
133
hemorrhagic/bloody tap (LP), patient has encephalitis/fever and HA
HSV Encephalitis (temporal lobes)
134
T/F: TB lumbar puncture/csf findings are consistent with a fungal organism, not bacterial
True to be careful (TB is a bacteria obvi).
| Low glucose, increased protein, predom lymphocytes. Tx with RIPE
135
Rocky mountain spotted fever presents with fever, headache, and rash that starts on wrists/peripherally and moves centrally to trunk. How do you tx?
Doxycycline (or Ceftriaxone)
136
T/F: Osteomyelitis is dx with bone scan
FALSE.
First do Xray, if neg do MRI
Best test: Biopsy . Follow with ESR and CRP as you treat with antibiotics for 4-6 weeks
137
Pain out of proportion
Abdominal: Mesenteric Ischemia
| Skin infection/cellulitis: Necrotizing fasciitis
138
Crepitus, rapidly progressive cellulitis and sicka s shit, Blue Gray Discoloration, Pain Out Of Proportion
Necrotizing fasciitis
139
Skin infection with crepitus
1. Gas gangrene (c perfringens)...penetrating wound gets contaminated. Debridement and PCN + Clindamycin
2. Nec Fas: staph and strep. pain out of proportion, blue grey discoloration. Debride and antibiotics...ampicillin, clinda, idk everything
140
location of: Primary TB; Reactivation TB
Primary: LOWER lobes and middle. "Lobar pneumonia/cavitation/caseating granuloma/ghon complex"
Reactivation: Apex. hemotysis/night sweats/wt loss
141
+PPD, - CXR Tx
| +PPD, + CXR Tx
-CXR: Exposure only (not infected)...INHx9mo (w/B6)
| +CXR: Get AFB Smear. + = Active TB = RIPE. -= Latent = INH x9mo + B6
142
Patient has sxs of TB/acute ill, how do you manage?
Can't wait for PPD
1. Get a CXR and AFB
+CXR, +AFB: Active TB = RIPE
+CXR, -AFB: Latent TB = INH + B6
-CXR, -AFB: Something else. can do NAAT and PCR to 100% ruled out if they ask.
Note: -CXR but 6 weeks later +AFB culture = MAC
143
RIPE side effects
Rifampin: red urine
INH: Neuropathy (give B6)
Pyrazinamide: GOUT (hyperuricemia)
Ethambutol (optic neuritis/red green color blindness)
ALL are HEPATOtoxic
144
Tachy tachy white hot
```
SIRS
Tachycardia >90
Tachypnea >20
Wbc>12
T>38
```
145
Ambulatory pneumonia is basically acute bronchitis (fever, cough, -CXR, +sputum) or "atypical pneumonia" (+bilateral infiltrates on cxr). How do we tx these?
Azithromycin (alt: doxy, moxifloxacin)
146
subacute pneumonia, CXR shows bilateral fluffy infiltrates, LDH is elevated, dx is made on Silver Stain. Dz and Tx?
```
PCP pneumonia (HIV pt)
IV Bactrim. If hypoxemic, add Steroids
```
147
bugs of pneumonia
```
Strep pneumo: #1
H flu: COPD/SMOKER
Legionella: GI + CNS sx. get Urine Ag
Klebsiella: EtOH
Chlamydia: Placenta/sheep. Serum AB
```
148
Ambulatory (outpatient aka acute bronchitis) Pnemonia tx vs Inpatient CAP vs Inpatient HCAP
Ambulatory: Azithromycin (alt: doxy, moxi)
In CAP: Ceftriaxone + Azithromycin
In HCAP: Vancomycin + Pip/Tazo
PCP (Bactrim and steroids) and Influenza (Oseltamavir)
149
Fever + Cough ddx (broad)
Bronchitis (-CXR. not as sick. PO/home tx)
Pneumonia (+CXR more sick. IV/hospital tx)
Abscess (Cavitations. IV/hospital)
(viral flu is technically on the ddx also. +myalgia)
150
Healthcare associated pneumonia bugs and def
Pseudomonas and MRSA: Tx with Pip/Tazo + Vanc
| <90 days from health exposure; >48 hr post admit
151
Tx of community acquired pneumonia
Ceftriaxone + Azithromycin
OR
Moxifloxacin
152
Tx of acute bronchitis/ambulatory pneumonia
Azithromycin only (CAP = Ceftriaxone also)
153
How do you treat abscess in lung? i.e. Fever and cough, +CXR for cavitation, foul breath etc
Ceftriaxone and Clindamycin. do NOT drain lung abscess
