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Flashcards in ID Deck (52):
1

Bacterial meningitis empiric treatment

?hospital-acquired

Vanc/ceftriaxone (or cefotax)

+ amp (>50 yo)

If hospital acquired, then cefepime or merrem instead of 3rd gen ceph

2

Encephalitis + ovarian teratoma (50%)

Psych symptoms

Seizures

Autonomic instability

Anti-NMDA R encephalitis

3

Skin ulcer, evolve from painless nodules, in neutropenic patient

Pseudomonas (ecthyma gangrenosum)

4

Empiric tx for non-purulent and purulent cellulitis

1. Dicloxacillin, cephalexin, clinda

2. Bactrim, clinda, doxy, minocycline, linezolid (iv vanc if bad)

5

Nec fasc treatment

Vanc
Imipenem
Clindamycin
Debride

6

Abscess < 5 cm treatment

I&D only

7

Bat & bird droppings

Histo

8

Rabbits

Franciscella

9

Bird exposure

Chlam. Psittaci

10

Pseudomonas RFs

Bronchiectasis
Pred > 10
Broad abx > 7 days in preceding month
Malnutrition

11

Tick bite
Fever
Lymphocytic meningitis
Petechial rash

Dx & Tx

RMSF

Doxycycline

Can have negative antibodies

12

Tick bite
Erythema migrans
Meningitis

Dx & Tx

Lyme

Doxycycline

13

HIV
Fever,chills,sweats,weight loss after starting therapy
LAD, HSM, anemia, leukopenia, increase ALP

Dx & Tx

DMAC and IRIS

Clarithromycin, ethambutol

14

Coccidioides meningitis

Tx

Fluconazole

Second - itraconazole

(Caspo does not penetrate CSF)

15

Neurosyphilis concerns

Next step...CSF or treat?

CSF studies

If positive, then IV PCN

16

TB treatment duration - reasons to prolong

2 mo initiation phase

4 mo continuation

7 mo continuation if:
No pyrazinamide
Cavitation and + sputum after initiation
Once weekly INH and rifapentamine and + sputum after initiation

17

5 mm positive PPD

10 mm positive PPD

15 mm positive PPD

Recent exposure
HIV +
Fibrotic changes on XR c/w old TB
Immunosuppressed > 15 mg pred for 4 weeks

IVDU
Homeless, prisons, LTAC
Recent immigration from country with high prevalence
Lab personnel
Hospital workers

Anyone

18

Post-exposure PPx for HIV

Pre-exposure PPx

Tenofovir-emtracirabine + raltrgravir

Tenofovie-emtracitabine

19

Late complement deficiency

Recurrent meningococcal meningitis, gonococcal infections

20

CVID

Recurrent sinusitis, pneumonia

21

Classical complement deficiency

Infection with encapsulated bacteria (strep pneumonia) etc

22

Brain abscess

-from odontogenic source

- from neurosurgical source

Tx

Penicillin + metronidazole
(Mixed organisms)

Vanc + Merrem (pseudomonas)/3rd gen ceph

23

Uncomplicated cutaneous Anthrax

Systemic anthrax

Tx

Cipro/levaquin/moxi/doxy

Add one or two bacteriocidal agents (imipenem, rifampin, doxy)

24

Astmptomatic bacteriuria in pregnancy

Treat it

Don't use nitrofurantoin if <30 days from delivery

25

Varicella exposure PPx

1 Immunocompetent

2 Immunocompromised

Vaccine

Immune globulin (pregnant women too)

Give if 4 days within exposure

26

Cervicitis treatment

PID treatment (requiring hospitalization)

Rocephin + axithromycin x 1

Cefotetan + doxy

27

Outdoors + fever + focal weakness

West Nile

Get CSF Ab, not PCR

28

Sudden high fever + frontal/retro-orbital pain + myalgia/low back pain (break bone fever) followed by rash

Usually travel history

Leukopenia, thrombocytopenia, increased lft

Dengue

29

Pneumococcal schedule for immunocompromised and HIV

PCV-13 now

PCV-23 8 weeks later

30

When is active TB not contagious

2 weeks of treatment

Improved symptoms

3 negative sputum smears

31

Drug of choice for candidemia

Echinocandins

32

Signs / RFs for disseminated histo

Fever

Weight loss

HSM

AIDS patient or heme malignancy

Ohio river valley or Central America

33

Sinus infection

Immunocompromised

Septate hyphae with acute angle branching

Positive galactomannan Ag

Aspergillus sinus infection

Voriconazole

34

Rapid dementia

+ 14.3.3 protein in CSF

Myoclonus

CJD

35

Small red dots starting in buccal mucosa - spreads to hands and face , then arms legs and feet

Macules --> papules --> vesicles

Smallpox (variola)

36

Conjunctivitis

Cough

Coryza

Then rash 2-4 days later (buccal white spots then morbilliform rash to face/neck then extremities)

Measles (rubeola)

37

Skin infection

Nail salons - pedicure

Rash 3-4 weeks after

Myco fortuitum

(Marinum a/w fish tanks)

38

RFs for drug-resistant strep pneumonia

Treatment?

Age > 65
Alcoholism
Immunosuppressive
COPD
Chronic liver or kidney disease
Recent (3-6 months) beta-lactam, macrolide, or FQ abx

Moxi + Doxy / macrolide

39

Coinfectuon with Lyme

Fever

Thrombocytopenia

Leukopenia

Anaplasmosis (anaplasma phagocyto)

40

Chlamydia treatment

GC treatment

Azithro

Or doxy or FQ

Rocephin

Or cefixime

41

Latent TB treatment

INH 9 months

OR

Rifampin 4 months

42

MAC treatment

Clarithromycin/azithromycin

+ ethambutal

+ rifampin/rifabutin

43

Fever

Abd pain

Constipation then diarrhea

Bradycardia

HSM

Africa, Asia, Latin America

Sometimes rash

Typhoid fever

44

Western Africa

Fever

Abd pain

Headache

Hemorrhage

Lassa fever

45

Travel to Arabian peninsula

Respiratory illness with viral like syndrome

Often progresses to pneumonia

Middle East respiratory syndrome

46

CAP coverage suspect pseudomonas

Beta lactam

Aminoglycoside

FQ

47

Crypto meningitis treatment

AMB + flucytosine

Then flucytosine maintenance

48

Ohio river valley, Mississippi

Pulmonary infection

Skin or bone findings

Blasto

49

Ohio river valley, Mississippi

Bad lung infection

Histo

50

Osteomyelitis +

1. Cat or dog bite

2. Foot puncture

3. Sickle cell patient

4. Vertebrae

Organisms?

Pasteurella

Pseudomonas

Salmonella (or staph)

Staph aureus

51

Mild babesiosis tx

Atovaquone and azithro

52

Severe babesiosis tx

Quinine and clinda