Flashcards in ID Deck (53):
What is the first line treatment for Rocky Mountain spotted fever?
Doxycycline, regardless of age.
What type of infection does clindamycin treat?
Gram positive infections.
It has some MRSA coverage.
What anabiotics are used to treat enterococcus?
"VALerie puked her guts out until she started her antibiotics."
V = Vancomycin
A = Ampicillin
L = Linezolid
"Puked her guts out" = enterococcus
What are the first generation cephalosporins and what do they cover?
Cover: staph, strep, PEcK (Proteus, E. coli, Klebsiella)
Do not cover MRSA.
What are the second generation cephalosporins and what do they cover?
"The FOX's FUR is FACtually the best for fighting TETANs and PEcKing HENs."
FOX = cefoxitin
FUR = cefuroxime
FAC = cefaclor
TETAN = cefotetan
PEcK = Proteus, E. coli, Klebsiella
HEN = Haemophilus, Enterobacter, Neisseria
"They are powerful against those NEGATIVE Nancys."
Good Gram-negative coverage.
What are the third generation cephalosporins?
- Not good G-positive coverage.
- Good G-negative coverage
- Great for CNS infections
- Most THREE generation drugs have "T" within THREE letters of the "F." CefpodoXime is the Xception.
- cefTAZadime is good for pseudoMONas - think of TAZMONian devil.
What are the fourth generation cephalosporins?
- Extended spectrum
- G-positive coverage
- Good CNS penetration
- Broader G-negative coverage
What does metronidazole treat?
- Anaerobic infections
- Intra-abdominal infections
"Imagine a woman traveling on an underground, stuffy METRO to GET BCG clothing."
G = giardia
E = entamoeba
T = trichimonas
B = bacteroides
C = clostridium
G = gardnerella
What are the big gram-positive bacteria?
"I am POSITIVE that when you ENTER the LISTserve, you will feel DOUBLY CLAUSTrophobic and may even make some CORNEY jokes. Don't stress. We will STRIP you of that and make sure you have enough STAFF to get the job done."
POSITIVE = gram positives
ENTER = enterococcus fecalis
LIST = listeria monocytogenes
DOUBLY CLAUST: 2 claust infections
- clostridium tetani
- clostridium botulinum
CORNEY = cornynebacterium diphtheriae
STRIP = streptococcus
STAFF = staphylococcus
What are two types of alpha hemolytic streptococcus?
What are two types of beta hemolytic streptococcus?
aB = agalactiae, Group B strep
pA = pyogenes, Group A strep
Describe what streptococcus looks like.
Gram-positive cocci in pairs and chains.
Describe but staphylococcus looks like.
Gram-positive organisms in clusters.
What is coagulase negative staphylococcus?
What is Bartonella henselae and how is it treated?
- Cat scratch disease
- Resolves on its own
- Treat if patient is immunocompromised or has severe symptoms (HSM):
What diseases can be caused by chlamydia trachomatis?
- Pneumonia (in neonates, staccato cough)
- Lymphogranuloma venereum (starts with a small, nontender papule or shallow ulcer that resolves and then a tender unilateral inguinal lymph node that ruptures, relieves the pain, and then drains for months)
How do you test for and treat chlamydia trachomatis?
PCR of cells
Obligate intracellular organism
Azithromycin x 1
Doxycycline x 7 days
Treat conjunctivitis with oral erythromycin to eradicate nasopharyngeal colonization that can cause pneumonia
Which anabiotics treat pseudomonas?
"3 C's, 2 P's, and AZ's!"
Antibiotics that have the letters "AZ": AZtreonam, ceftAZidime, tAZobactam
Describe the features of a cryptococcus infection.
"Imagine a giant CAWing crow wearing a huge RED TURBAN. (CAW: bird exposure; RED: immunocompromised; TURBAN: India ink) The turbine is so heavy that it almost breaks the crow's neck. (NECK PAIN: meningitis)
- Travel to Northwest US
- Exposure to bird droppings (pigeon)
Describe the features of blastomycosis infection.
- East of the Mississippi and Central America
- Broad based budding yeast
- Found near water
- Causes pneumonia, flu like illness, skin lesions
Describe the features of histoplasmosis infection.
- Ohio or Mississippi
- Exposure to bird droppings
- Flu like illness or asymptomatic and cleared without intervention but it leaves CALCIFICATIONS that look like TB on X-ray
- May have pulmonary fibrosis, HSM, mediastinal/hilar CALCIFICATIONS
What are the features of arbovirus encephalitis?
- Encephalitis (confusion, lethargy)
- Exposure to mosquitoes (California, St. Louis)
- Diagnose with acute and convalescent antibody titers (no PCR available)
Describe vericella zoster virus lesions.
"Dew drop on a petal"
Appear in crops at different times - different stages of healing throughout body
Rash starts on trunk and then spreads to face and extremities
What are the testing recommendations for HIV in a newborn?
- Obtain DNA PCR at birth
- Repeat DNA PCR at 2, 4, 6 month visits. If negative, baby is probably negative. If any are positive, repeat to confirm.
- Maternal anti-HIV antibodies may stay for 18 months. Check antibodies at 12 or 18 months to make sure they clear.
* Note: RNA PCR is used to check viral load
What is the treatment for a baby born to an HIV-positive mother?
- Mom didn't get AZT or Nevirapine: start AZT within 72 hrs. Continue x 6 wks.
If 4 days have passed, it's too late to start AZT.
What are the common side effects of HIV medications?
Pancreatitis (the "d" drugs - ddI, ddC)
Steven Johnson syndrome
CNS effects (neuropathy)
Which animals transmit rabies?
What are the classic symptoms of measles?
Cough, conjunctivitis, and coryza
- First comes the three C's, then Koplik spots, then rash.
- Rash starts at head and progresses down
How long are patients with measles contagious for?
From four days prior to the onset of the rash until four days after the rash appears.
What is the treatment for rabies exposure?
1. Standard wound care
2. Human rabies immunoglobulin (HRIG)
3. Four vaccine doses
What is the treatment for measles exposure?
- < 6 days since exposure in unimmunized kids < 6 months: give MIG
- < 3 days since exposure in unimmunized kid > 6 months: give MMR
Give another MMR at 12 months
- Between 3-6 days since exposure in high risk (i.e., immunocompromised, <5yo, unknown IZ status) unimmunized kid, give measles immunoglobulin (MIG)
Give MMR#1 5 months later
What are the features of congenital rubella?
"The DEAF and dumb CAT ate my BLUEBERRY MUFFIN and stepped on my PDA."
CAT: cataracts, microophthalmia
BLUEBERRY MUFFIN: blueberry muffin rash
Syndrome usually develops after exposure during the first trimester.
What are the symptoms of a rubella infection?
- Mild fever
- Maculopapular rash that starts on the face and spreads to trunk and extremities
- Diagnose with IgM
What are the features of Lyme Disease?
"BAKE a key LYME pie."
B: Bell's palsy
K: Kardiac block
E: Erythema migrans (bulls eye lesion at site of tick bite, appears 1-2 wks after bite.
Caused by BORRELIA BURGDORFERI.
What are the symptoms of leptospirosis?
E: encephalitis (& meningitis) - aseptic
P: pain in abdomen
T: transmitted through (animal) urine - dog, cat, squirrel
O: occipital headache
S: suffusion (nonexudative conjunctivitis)
P: pericorneal reddening, photophobia
R: renal (and liver) failure
O: looks like a ❤= bradycardia
What are the symptoms of trichomonas vaginalis?
- Yellow green discharge, bubbly, frothy
- pH > 4.5
- Intensely pruritic
- Strawberry cervix
- Protozoa, motile flagella
- Tx: metronidazole x 1
What is cryptosporidium cause?
- Watery diarrhea lasting seven days to one month
- Fecal oral transmission
- Test for it with DFA or PCR
- Tx: supportive
What does TORCH stand for?
Other (Varicella, Syphilis)
What are the features of toxoplasmosis?
Diffuse intracerebral calcifications
Blueberry muffin syndrome
Transmitted via cat litter
Diagnosed with IgM titers or immunoflorescence
How do you test for syphilis in a newborn?
- Non-treponemal tests (+RPR, VDRL) can be false positives.
- To confirm: FTA (treponemal test)
- If mom + but FTA was not done, get FTA in baby
- If FTA + in baby, get titers
- If mom was treated and titers are lower than mom's, observe (those are mom's IgGs that crossed placenta)
- If mom was treated <1 month ago, treat
- If mom was treated with erythromycin, treat (erythromycin doesn't cross placenta)
What are the symptoms of congenital syphilis?
If untreated -> perforated palate and perforated nasal septum, hearing loss, Hutchinson teeth
What are the symptoms of congenital cytomegalovirus infection?
Periventricular intracerebral calcifications
Hearing loss (sensorineural)
Blueberry muffin Syndrome
Which G.I. infection should always be treated?
Azithromycin, Ceftriaxone, Ciprofloxacin
Which virus is responsible for causing watery diarrhea after eating raw seafood?
Which strain of E. coli is associated with HUS?
HAT: Hemolytic anemia
Acute renal failure
Which strain of E. coli is associated with traveler's diarrhea?
Non- bloody diarrhea
Crampy abdominal pain
Can be associated with fever and vomiting
Use a macrolide (azithromycin) if diarrhea persists for greater than one week
What are the symptoms of Salmonella Non-Typhi?
Green, malodorous diarrhea
?blood in stool
Ice cream, poultry, egg ingestion
Exposure to pet Iguana
What are the symptoms of typhoid fever?
Caused by Salmonella typhi
Fever, diarrhea, abdominal pain, ROSE SPOTS
Treatment: ceftriaxone, cefotaxime
What does yersinia enterocolitica cause?
Fever and diarrhea after eating raw pork or unpasteurized milk.
Pseudoappendicitis, erythema nodosum, reactive arthritis
What does clostridium perfringens cause?
Non-bloody diarrhea after eating raw turkey or beef.
What are the symptoms of tularemia?
- Causes glandular or ulceroglandular disease.
- Caused by pleomorphic gram-negatives
- Fever, HSM, LAD, ulcers
- Tick borne illness from deer or rabbit
- Tx: gentamicin or streptomycin+tetracycline
What causes progressive ptosis in a baby?
- Progressive descending weakness
- Tx: supportive