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Flashcards in ID Deck (53):
1

What is the first line treatment for Rocky Mountain spotted fever?

Doxycycline, regardless of age.

2

What type of infection does clindamycin treat?

Gram positive infections.

It has some MRSA coverage.

3

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

4

What are the first generation cephalosporins and what do they cover?

Cephalexin
Cefazolin

Cover: staph, strep, PEcK (Proteus, E. coli, Klebsiella)

Do not cover MRSA.

5

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.

6

What are the third generation cephalosporins?

Ceftriaxone
Cefotaxime
Ceftazidime
Cefpodixime

- 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.

7

What are the fourth generation cephalosporins?

Cefepime
- Extended spectrum
- G-positive coverage
- Good CNS penetration
- Broader G-negative coverage

8

What does metronidazole treat?

- Parasites
- Anaerobic infections
- Intra-abdominal infections

"Imagine a woman traveling on an underground, stuffy METRO to GET BCG clothing."
"GET BCG"
G = giardia
E = entamoeba
T = trichimonas
B = bacteroides
C = clostridium
G = gardnerella

9

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

10

What are two types of alpha hemolytic streptococcus?

Viridans
Pneumoniae

11

What are two types of beta hemolytic streptococcus?

aBpA
aB = agalactiae, Group B strep
pA = pyogenes, Group A strep

12

Describe what streptococcus looks like.

Gram-positive cocci in pairs and chains.

13

Describe but staphylococcus looks like.

Gram-positive organisms in clusters.

14

What is coagulase negative staphylococcus?

Staphylococcus epidermidis

15

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):
Macrolide
Cephalosporin
Doxycycline
Bactrim

16

What diseases can be caused by chlamydia trachomatis?

- Urethritis
- Conjunctivitis
- PID
- 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)

17

How do you test for and treat chlamydia trachomatis?

PCR of cells
Obligate intracellular organism

Azithromycin x 1
OR
Doxycycline x 7 days

Treat conjunctivitis with oral erythromycin to eradicate nasopharyngeal colonization that can cause pneumonia

18

Which anabiotics treat pseudomonas?

"3 C's, 2 P's, and AZ's!"

Cephalosporins (cefepime)
Ciprofloxacin (fluoroquinolones)
Carbapenems (meropenem)
Polymyxin B
Pipercillin, ticarcillin
Antibiotics that have the letters "AZ": AZtreonam, ceftAZidime, tAZobactam

19

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)

20

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

21

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

22

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)

23

Describe vericella zoster virus lesions.

Chicken Pox
"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

24

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

25

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.

26

What are the common side effects of HIV medications?

Pancreatitis (the "d" drugs - ddI, ddC)
Steven Johnson syndrome
Liver toxicity
Pneumonitis
CNS effects (neuropathy)
Neutropenia
Renal problems

27

Which animals transmit rabies?

BCDFRSW

Bat
Cat
Dog
Fox
Raccoon
Skunk
Woodchuck

28

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

29

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.

30

What is the treatment for rabies exposure?

1. Standard wound care
2. Human rabies immunoglobulin (HRIG)
3. Four vaccine doses

31

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

32

What are the features of congenital rubella?

"The DEAF and dumb CAT ate my BLUEBERRY MUFFIN and stepped on my PDA."

DEAF: deafness
CAT: cataracts, microophthalmia
BLUEBERRY MUFFIN: blueberry muffin rash
PDA: PDA

Syndrome usually develops after exposure during the first trimester.

33

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

34

What are the features of Lyme Disease?

"BAKE a key LYME pie."

B: Bell's palsy
A: Arthritis
K: Kardiac block
E: Erythema migrans (bulls eye lesion at site of tick bite, appears 1-2 wks after bite.

Caused by BORRELIA BURGDORFERI.

35

What are the symptoms of leptospirosis?

LEPTOSPIRO

L: lymphadenopathy
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
I: iridocyclitis
R: renal (and liver) failure
O: looks like a ❤= bradycardia

36

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

37

What is cryptosporidium cause?

- Watery diarrhea lasting seven days to one month
- Fecal oral transmission
- Test for it with DFA or PCR
- Tx: supportive

38

What does TORCH stand for?

Toxoplasmosis
Other (Varicella, Syphilis)
Rubella
Cytomegalovirus
HSV

39

What are the features of toxoplasmosis?

Diffuse intracerebral calcifications
Hydrocephalus
Chorioretinitis
Adenopathy
Thrombocytopenia
Hepatosplenomegaly
Jaundice
Blueberry muffin syndrome
Transmitted via cat litter
Diagnosed with IgM titers or immunoflorescence

40

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)

41

What are the symptoms of congenital syphilis?

Maculopapular rash
Hepatosplenomegaly
Generalized lymphadenopathy
Peeling skin
If untreated -> perforated palate and perforated nasal septum, hearing loss, Hutchinson teeth

42

What are the symptoms of congenital cytomegalovirus infection?

Chorioretinitis
Microcephaly
Periventricular intracerebral calcifications
Hearing loss (sensorineural)
Cognitive defects
Seizures
Thrombocytopenia
Hepatosplenomegaly
Blueberry muffin Syndrome

43

Which G.I. infection should always be treated?

Shigella
Azithromycin, Ceftriaxone, Ciprofloxacin

44

Which virus is responsible for causing watery diarrhea after eating raw seafood?

Norwalk virus

45

Which strain of E. coli is associated with HUS?

EHEC
Bloody diarrhea

HAT: Hemolytic anemia
Acute renal failure
Thrombocytopenia

46

Which strain of E. coli is associated with traveler's diarrhea?

ETEC
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

47

What are the symptoms of Salmonella Non-Typhi?

Fever
Green, malodorous diarrhea
?blood in stool
Ice cream, poultry, egg ingestion
Exposure to pet Iguana
No treatment

48

What are the symptoms of typhoid fever?

Caused by Salmonella typhi
Fever, diarrhea, abdominal pain, ROSE SPOTS
Treatment: ceftriaxone, cefotaxime

49

What does yersinia enterocolitica cause?

Fever and diarrhea after eating raw pork or unpasteurized milk.

Pseudoappendicitis, erythema nodosum, reactive arthritis

50

What does clostridium perfringens cause?

Non-bloody diarrhea after eating raw turkey or beef.

51

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

52

What causes progressive ptosis in a baby?

Clostridium botulinum

- Progressive descending weakness
- Tx: supportive

53

How do you treat Corynebacterium diphtheria?

Metronidazole or Erythromycin