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1
Q

Honey colored crusts

A

Impetigo

  1. Topical Mupirocin
  2. Keflex
    * *Bactrim/Doxy for MRSA
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2
Q

Painful erythematous facial rash, clear margins

A

Erysipelas (B-hemolytic strep > staph)

1. PCN or Keflex

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3
Q

Cellulitis (Bugs)

  • Common
  • DM
A
  1. Staph or Strep pyogenes

2. Pseudomonas

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4
Q

Human Bite

A

Eikenella

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5
Q

Animal Bite

A

Pasteurella (Cats)

Capnocytophaga (Dogs)

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6
Q

Type 1 Nec Fasc

A

Polymicrobial (Anaerobes + GNRs)

DM, Immunosuppressed, IV Drugs, Peripheral vascular disease

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7
Q

Type 2 Nec Fasc

A

B-hemolytic Strep or Staph

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8
Q

A complication of necrotizing fasciitis is ***

A

Compartment Syndrome

Muscle weakness, paresthesias

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9
Q

Presence of gas in soft tissue on a CT or MRI indicates __________.

A

Necrotizing Fasciitis

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10
Q

Nec Fasc treatment

A

Group A Strep - PCN +/- Clinda (toxins
Mixed - Vanc/Zosyn
Surgical consult for debridement

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11
Q

Both orbital and pre-orbital cellultits present with erythema and eye pain - what symptoms are seen in orbital cellulitis alone?

A 
Oculomotor dysfunction
Proptosis
Chemosis
Pain w/ movement 
Decreased visual acuity
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12
Q

Complications associated with orbital cellulitis

A

Blindness
Meningitis
Cavernous Sinus Thrombosis

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13
Q

If concerned for orbital cellulitis what test confirms this

A

CT of the orbits
Blood cultures
CBC

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14
Q

Orbital Cellulitis Rx

A

Cover GNRs - IV Ceftriaxone or Amp/Sulbactam
Cover MRSA - Vanc
++Surgical Consult

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15
Q

In osteomyelitis ESR And CRP are usually _________ and blood cultures are _________.

A

Elevated

Negative

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16
Q

How to diagnose osteomyelitis

A
  1. CBC, ERR/CRP, cultures
  2. Plain films (may be nml if infection < 2 weeks)
  3. MRI (bone scan if CI)
  4. Bone biopsy if MRI/bone scan are abnormal
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17
Q

Osteomyelitis Treatment

A

Unless pt is septic delay antimicrobial therapy until specimen obtained through surgical debridement.

Broad spec if septic

4-6 weeks of directed therapy

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18
Q

Patients with sickle cell get OM from what organism

A

Salmonella

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19
Q

What patients are at risk for Pseudomonas OM

A

Diabetics
IV Drug use
Lower extremity ulcers

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20
Q

Which cases of OM can resolve with antibiotics alone (i.e. no surgical debridement)?

A

Axial skeleton

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21
Q

Risk Factors for Septic Arthritis

A 
Instrumentation - Injection, arthroscopy, etc
Joint damage - OA, RA, trauma
Prosthetic Joint (staph epi)
Gonococcal infection
Bacteremia
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22
Q

Fluid for Septic Arthritis

A

> 50K WBC ++ Neutrophils

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23
Q

Septic Arthitis Treatment

A

Surgical washout

4-6 weeks of antibiotics

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24
Q

Fever, chills, N/V, abdominal pain, +/- palpable mass

A

Diverticulitis - clinical diagnosis often made on CT

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25
Diverticulitis treatment | Diverticulitis + Abscess
Antibiotics (GNR and anaerobes) Cipro and Metronidazole Surgical drainage + Abx
26
The leading cause of encephalitis is _______.
HSV - IV Acyclovir
27
Encephalitis symptoms
Fever/malaise (viral prodrome) Confusion, seizures, focal neuro deficits Headaches, photophobia, +/- meningeal signs
28
Patient presenting w/ bizarre behavior, speech disorder, gustatory/olfactory hallucinations, or acute hearing impairment.
HSV Encephalitis MRI - bilateral temporal lobe LP - HSV PCR and culture
29
Fever and AMS in late spring, summer early autumn
West Nile Encephalitis
30
West Nile can also present with symptoms of transverse myelitis _________
Spinal cord inflammation | Extrapyramidal symptoms or flaccid paralysis
31
Treatment for West Nile Encephalitis
Supportive
32
Common causes of meningitis in neonates
Group B strep, E. coli, Listeria
33
Common causes of meningitis in infants
Strep pneumo, N. meningitidis, H flu
34
Common causes of meningitis in age 2-50
Strep pneumo, N. meningitidis
35
Common causes of meningitis in elderly (> 50 yo)
Strep pneumo, N. meningitidis, Listeria
36
Meningitis Broad Spec Coverage
Vanc Ceftriaxone Ampicillin - Bactrim if allergic +/- IV Acyclovir
37
For meningitis begin empiric therapy _______ blood cultures and _______ LP.
Immediately after getting blood cultures | **Don't wait for LP
38
If Strep Pneumo meningitis is suspected give ____________ prior to antibiotics
Dexamethasone - decreases mortality
39
Strep pneumo meningitis
GS: GP cocci in pairs and short chains | Vanc + Ceftriaxone + Dexamethasone
40
N meningitidis meningitis
GN diplococci | Ampicillin or Ceftriaxone
41
Listeria monocytogenes meningitis
GP rods | Ampicillin
42
Strep agalactiae (Group B Strep)
GP cocci in pairs and short chains | Ampicillin
43
H flu B
GN coccobacilli **unvaccinated patients** Ceftriaxone
44
Most common causes of acute sinusitis
1. Viruses 2. Bacteria - Strep pneumo, Hflu Moraxella * *Mucor in diabetics
45
When to give antibiotics for sinusitis
Augmentin vs Doxy > 10 days Improve then worsen
46
Treatment of otitis externa
Oxfloxacin + steroids | - usually pseudomonas, sometimes Staph aureus
47
Pharyngitis is typically due to ____________.
Viral causes: Rhinovirus, Adenovirus, EBV | Group A strep (25%)
48
Scoring for Strep Infection
``` Anterior cervical LAD Tonsillar exudate History of Fever Absence of cough 2-3 pts test 4 points treat ```
49
Treatment for Group A Strep
``` Penicillin (Macrolide if allergic) Chronic carriers (+culture, asymptomatic) - Clinda ```
50
Rheumatic Fever
Fever, arthritis, carditis, chorea, rash
51
Which patients should you consider urine Legionella and S pneumo
``` ICU admission Fail outpatient therapy Alcohol use disorder +Pleural effusion Asplenic or chronic liver disease ```
52
Typical Pneumonia pathogens
Strep pneumo H Flu Staph aureus (in setting of flu)
53
Atypical pneumonia pathogens
``` Mycoplasma Chlamydia Moraxella Legionella **Azithromycin** ```
54
CURB-65
``` Confusion Urea > 19 RR > 30 BP < 90/60 Age > 65 ```
55
Treatment duration for PNA
CAP - 5 days HCAP 7-8 days MRSA/Pseudomonas 14 days
56
Who is at risk for PJP PNA
CD4 < 200
57
Findings in PJP PNA
Ground glass infiltrates Elevated LDH Bronch for pneumocystis
58
PJP Treatment
IV Bactrim for 3 weeks (IV Pentamidine)
59
Treatment for active TB
RIPE Rifampin, INH, Pyrazinamide Ethambutol - 8 weeks Rifampin, INH - 16 weeks
60
Treatment for latent TB
INH 6-9 months
61
Rifampin side effects
Red/orange body fluids | Hepatitis
62
INH SE
Peripheral Neuropathy (Give pyridoxine, B6) Hepatitis SLE-like syndrome
63
Pyrazinamide SE
Hepatitis | Hyperuricemia
64
Ethambutol
Optic Neuritis
65
True/False: Diagnose prostatitis by obtaining urine cultures before and after prostate massage.
True
66
Treat acute bacterial prostatitis with (3 options)
Fluoroquinolone, or IV piperacillin/tazobactam | or Ceftriaxone 2 weeks
67
Chronic bacterial prostatitis
Bactrim or fluoroquinolone for 4-6 weeks
68
Rashes that affect the palms and soles (9)
``` Coxsackie - hand/foot/mouth Rocky Mountain Spotted Fever Neiserria meningococcemia 2˚Syphilis Janeway Lesions (bacterial endocarditis) Kawasaki Disease - vasculitis Measles Toxic Shock Reactive Arthritis ```
69
How to diagnose 1˚ Syphilis
Specific treponemal test - FTA-ABS, MHA-TP, darkfield shows spirochetes. Nontreponemal to confirm RPR or VDRL
70
Who gets an LP for syphilis
If they've had the disease for > 1 year Neuro/Ophthalmic signs VDRL ≥ 1:32
71
Rx for genital herpes
Acyclovir for 7-10 days during first infection | Repeat can get acyclovir or valcyclovir x5 days
72
T/F: Treat chlamydia with a single po dose of Azithromycin and gonorrhea with single IM dose of Ceftriaxone.
True - always treat both and always treat partners

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