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Flashcards in IDS Deck (190):
1

In the assessment of acutely ill patients Fever may be absent on which patients

Elderly patients
Immunocompromised hosts
uremic
Cirrhotic
on GC's or NSAIDS

2

Diagnostic work up for patients with severe infection

Blood For various exams ( Culture, Chem, CBC)- at the time Iv is placed and before giving antibiotics
For I E:3 sets of Blood cs
If Asplenic: Blood some dr: flowell - Jolly bodies
Buffy coat exam. Presence oF bacteria(> 10 to the 6 th us10 to the 4th in patients with intact spleen)
Blood smears: pX s at risk of parasitic infection: malaria, Babesiosis
LP For possible meningitis( before antibiotic and in the absence of pocst neurologic deficits)
Focal Abscesses: CT /MRI
Other Diagnostics: wound cultures etc.

3

Infections requiring urgent surgical attention

subdural em pyema, spinal epidural abscess, otolarhyngologic surgery for possible mucormycosis cardiothoracic Surgery ffor critically ill patients with acute endocarditis

4

Infections that require rapid intervention before other therapeutics /diagnostics

necrotizing Fasciitis
clostridial myonecrosis

5

possible Etiologies for Septic stock

pseudomonas, gram negative enteric bacilli, Staph, Strep

6

purpura fulminans

N. meningitidis

7

meningococcemia treatment

penicillin/ceftriaxone

8

Toxic Shock Syndrome is caused by

GABHS, Staph Aureus

9

Treatment For Acute Bacterial Endocarditis

Ceftriaxone+ vancomycin
covering For the Following: S. aureus, HACEK, B -hemolytic Strep, Neisseria sp, S, pneumonia

10

Septic shock patients at risk of adverse outcomes

elderly patients with co - morbid, concurrent malignancy and neutropenia, recent surgery/ hospitalization

11

septic shock patients that may present with hypotension and moDs

Gram negative bacteremia ( P. aeruginosa, E. coli)
Gram positive infection ( Staph /Strep)

12

what is the role Of CRP and Procalcitonin in septic Shock patients

NOT For Dx but can Facilitate de - escalation of therapy

13

pink, blanching, maculapapular(trunk and ext) becoming hemorrhagic, forming petechiae

meningococcemia

14

Cutaneous manifestation of DIC

purpura Fulminans

15

E cthyma Gangrenosum

P. aeruginosa/ Aeromonas hydrophila

16

Focal skin lesions and overwhelming sepsis seen in patients with liver disease is usually caused by

vibrio vulnificus

17

causes septic shock in asplenic patients with infection Following a dog bite

Capnocytophagia caninormus

18

Sunburn - type rash s usually diffuse, on face, trunk and extremities seen on TSS patients

Erythroderma

19

Risk factors For Necrotising Fasciitis

bm, PVD, iv drug use

20

Bacterial meningitis is most commonly associated with

S. pneumonia, N. meningitidis

21

Predisposing risk factors For Listeria monocytogenes meningitis

cell mediated immune deficiency

22

Poor prognostic Findings For Bacterial meningitis patients:

coma,
hypotension,
meningitis due to S. pneumonia,
respiratory distress,
CSF glucose < l0mg/ dL,
CSF protein> 2.5
WBC 5000,
Na< 135

23

Cerebral malaria is caused by

Plasmodium Falciparum

24

Jugular septic thrombophiliabitis caused by Fusobacterium necrophorum

Lemierre's disease

25

Vaccines contraindicated For pregnant, Immunocompromised, HIV with CD4<200

MMR, varicella, zoster

26

HPV vaccine given to
a) Male b) Female

Males HPV 4
Females: HPV 2 and HPV 4

27

Zoster vaccination

single dose: for adults >/=60 years old regardless of prior episode of Herpes Zoster

28

Indications to Hib vaccine

Anatomical or Functional asplenia
sickle cell disease
undergoing Elective splenectomy( 14 or more days before)

29

Fever> 38.3 on at least 2 occasions > /= 3 weeks no known immunocompromised state and dx remains uncertain after a thorough investigation

Fever of Unknown Origin

30

More common non infectious causes of FUO

Large vessel vasculitis
Polymyalgia rheumatica
Sarcoidosis
Familial mediterranean fever
Adult onset Still's disease

31

Schnitzler's syndrome

FUO+ Urticaria
Bone pain
Monoclonal gammopathy

32

Most common cancer cause of FUO

Malignant Lymphoma

33

Miscellaneous cause of FUO

Exercise induced hyperthermia
Drug induced fever

34

Causes of drug induced fever

Allopurinol, carbamazepine, lamotrigine, phenytoin, sulfasalazine, furosemide, anti microbials, nevirapine

35

Exercise induced hyperthermia

Increase body temp associated with moderate-strenous exercise lasting 30mins to several hours not associated with inc in ESR, CRP

36

Most common infectious cause of FUO

Tuberculosis

37

Established imaging procedure in FUO

FDG-PET

38

For FUO pxs with TST positive or with anergy bit with granulomatous disease therapeutic trial with anti TB is indicated for how long

6 weeks

39

Recombinant IL 1 receptor antagonist given to FUO patients

Anakinra

40

Most common mode of entry of microbial pathogens into the alveolar level

Aspiration from oropharynx

41

Roles of alveolar macrophages in hosts defense

Phagocytic (innate)
antigen presenting cell to T cells (acquired)
produce many cytokines and mediators

42

Fever in pneumonia is due to

IL-1 and TNF

43

Peripheral leukocytosis and purulent secretions in pneumonia is due to

IL-8 and G-CSF

44

Capillary leak in pneumonia

Caused by inflammatory mediators released by alveolar macrophages and newly recruited neutrophils

45

Hypoxemia in pneumonia is due to

Alveolar filling

46

Causes of dyspnea in pneumonia

Decreased compliance due to capillary leak, hypoxemia, inc respiratory drive, secretions and interferon related bronchospasm

47

4 stages of lobar pneumonia

1. Edema/congestion
2. Red hepatization
3. Gray hepatization
4. Resolution

48

Predominant cells in gray hepatization

Neutrophils

49

Predominant cells in Resolution stage of Lobar pneumonia

Macrophages

50

Most common pattern in nosocomial pneumonia

Bronchopneumonia

51

Lobar pneumonia pattern is seen in

Bacterial CAP

52

VAP has what type of pneumonia pattern

Respiratory bronchiolitis

53

Typical bacterial pathogens in pneumonia

H. Influenza, s. Pneumonia, s. Aureus, klebsiella pneumonia, pseudomonas aeruginosa

54

Atypical bacterial pathogens in pneumonia

Mycoplasma, chlamydophila, legionella, Resp virus (influenza, adeno, human metapneumo, RSV)

55

Complications of anaerobic pneumonia

Abscess, empyema, effusions

56

Serious consequence of MRSA pneumonia

Necrotizing pneumonia

57

Risk factors for pseudomonas infection

Recent hosp/antibiotic therapy
Structural lung disease (bronchiectasis)
heart/renal failure
Alcoholism

58

Risk factors for Legionella infection

Recent hotel stay/cruise ship
Male
Smoking
Renal disease
Immunocompromised (malignancy, HIV)
DM

59

Adequate sputum specimen for culture

>25 pmns and <10 squamous cells per LPF

60

Indications for Blood culture for CAP

High risk patients (neutropenia, asplenia, complement deficiency)
chronic liver disease

61

CURB 65

Confusion
Urea >7
RR >30
BP <90/60
65 age more than

Score
0= Opd
1= ward
2= ICU

62

Sensitivity classification of pneumococcal strains

MIC
= 2 SUSCEPTIBLE
= 2-4 INTERMEDIATE
= 8 RESISTANT

63

Risk factors for penicillin resistant pneumococcal infection

Recent antimicrobial therapy
Age <2 or >65
Attendance at daycare centers
Recent hospitalization
HIV infection

64

Microbial infection resulting to necrosis and cavitation of the pulmonary parenchyma

Lung abscess

65

Primary lung abscess is due to

Aspiration of anaerobic bacteria or occur in the absence of an underlying pulmonary or systemic condition

66

Classification of lung abscess based on duration

Acute <4-6wks
Chronic >6wks (40%)

67

Most common location of primary lung abscess

Posterior upper and superior lower
R>L

68

Most common cause of secondary lung abscess

Pseudomonas, gram negative rods

69

Preferred imaging for lung abscess

CT

70

Treatment for primary lung abscess

Clindamycin 600mg iv tid then with fever lysis and clinical improvement 300mg po qid
Iv beta lactamase followed by co amox
Tx ranging from 3-4wks to 14wks until clearance/regression

71

Indication for surgical intervention in lung abscess

Failure of antibiotic tx
>8cm size

72

Etiologic agents in community acquired native valve endocarditis

Oral cavity: viridans strep
Skin: staph
URT: HACEK
GIT: strep bovis/gallolyticus
GUT: Enterococci

73

Health care associated NVE

Staph aureus, CoNS, enterococci

74

Prosthetic valve endocarditis

Within 2 mos: s aureus, CoNS, gram neg bacilli, diph, fungi
2-12mos: CoNS
>12mos: community assoc NVE

75

Endocarditis among IV drug users

MRSA affecting tricuspid valve (right sided)
polymicrobial (left sided)

76

Pathogenesis in IE

Endothelial injury leading to direct infection by virulent organisms and development of platelet-fibrin thrombus (NBTE- non bacterial thrombotic endocarditis)

77

Nonsuppurative peripheral manifestation of subacute endocarditis and related to prolonged infection

Janeway lesions

78

Septic embolization seen in s. Aureus endocarditis

Osler's nodes

79

Focal dilations of arteries occuring at points in the artery wall that have been weakened by infection in the vasa vasorum or where septic emboli have lodged

Mycotic aneurysms

80

Diagnosis of IE based on DUKE'S CRITERIA

Definite: 2 major or 1 major 3 minor or 5 minor
Possible: 1 major and 1 minor or 3 minor

81

Hand foot and mouth disease

Coxsackie virus A16

82

Staphylococcal scalded skin syndrome

S. Aureus

83

Gas gangrene

Clostridium

84

Bullous impetigo

Staph aureus

85

Impetigo contagiosa

Strep pyogenes

86

Hot tub folliculitis

Pseudomonas

87

Swimmers itch

Schistosoma

88

Erysipelas

Strep pyogenes

89

Most common causes of infectious arthritis

S. Aureus, neisseria gonorrhea

90

Most common route of entry into the joints

Hematogenous

91

Common joint infection among patients with RA

Polyarticular

92

Periods of greatest risk to develop gonococcal arthritis among women

Menses and pregnancy

93

Culture results of patients with true gonococcal septic arthritis
Synovial fluid and blood

SF: positive in < 40%
Blood: negative

94

Treatment for true gonococcal septic arthritis

Ceftriaxone once local and systemic signs are clearly resolving the 7 day course may be completed with cefixime or ciprofloxacin or if penicillin susceptible, amox

95

Reiter's syndrome

Urethritis
Conjunctivitis
Uveitis
Oral ulcers
Rash

96

Most commonly affected bone with osteomyelitis in adults

Vertebra

97

Acute osteomyelitis is managed with

Antibiotics only

98

Gold standard for diagnosis of osteomyelitis

MRI

99

Most commonly associated with primary (spontaneous) bacterial peritonitis

Liver cirrhosis

100

Most common presentation of patients with primary peritonitis

Fever

101

Diagnostic finding of ascitic fluid of SBP patients

>250/mcL

102

Most common bacterial isolate in SBP

E. Coli or other gram neg
Typically single organism

102

Most common bacterial isolate in SBP

E. Coli or other gram neg
Typically single organism

103

Antimicrobial treatment for Primary (spont) bacterial peritonitis

3rd gen ceph (ceftriaxone, cefotaxime)
piptaz
Coverage: gram neg aerobic bacilli, gram positive cocci

104

Bacterial contamination of the peritoneum as a result of spillage from an intraab viscus

Secondary peritonitis

105

Diagnostics for secondary peritonitis

Abdominal tap RARELY indicated, ONLY done in trauma patients
Stable: abdominal CT
Unstable: surgery prior to imaging

106

Antimicrobial treatment for secondary peritonitis

Ticarcillin/clavulanate
Cefoxitin
Levox
Ceftri + metro

ICU pxs: imipenem, merop, ampi+metro+cipro

Coverage: gram neg aerobic bacilli and anaerobes

107

Most common bacteria associated with CAPD peritonitis

Staphylococcus

108

Most common anaerobic isolate in intraabdominal abscess

Bacteroides fragilis

109

Most common cause of intraabdominal abscess

Fecal spillage from a colonic source

110

Highest diagnostic yield for intraabdominal abscesses

Abdominal CT

111

Most common source of liver abscess

Disease of the biliary tract

112

Most common presenting sign of liver abscess

Fever

113

Single most reliable laboratory finding in liver abscess

Increased alkaline phosphatase (70%)

114

Most common pathogens isolated in liver abscess

If arising from biliary tree: gram negative aerobic bacilli
Pelvic and other intraabdominal source: mixed but mostly b. Fragilis
Hematogenous: staph, strep
Patients on chemo: candida
Amoebic: serologic test with positive result >90%

115

Management for liver abscess

Mainstay: drainage percutaneous or surgical
~ SURGICAL : presence of multiple, sizable abscesses, viscous abscess, asso dse req surgery or lack of response to percutaneous drainage (4-7days)

Medical: same as intraab sepsis and sec peritonitis

116

More common cause of splenic abscess

Hematogenous

117

Most common infection associated with splenic abscess

Bacterial endocarditis

118

Predisposing risks for splenic abscess

immunosuppressive therapy, hemoglobinopathies, other hematologic disorders( sickle cell)

119

Most sensitive diagnostic tool for splenic abscess

CT scan of the abdomen

120

Most common isolate for splenic abscess

Streptococci
St aph aureus( 2nd most common)

121

Standard management and best approach to patients with complex, multi localbr, multiple splenic abscess

Splenectomy with antibiotics ( adjunct)

122

Preferred approach to patients with high surgical risk and single<3cm splenic abscess

Percutaneous drainage

123

Portal of entry for perinephric and renal abscess

UTI( 75 %)

124

Most important risk factor for Renal Abscess

Nephronthiasis obstructing urinary flow

125

Most common isolates in Renal Abscess

E .coli, Proteus, klebsiella

126

Most useful diagnostic modalities for Renal Abscess

Renal UTZ and Abdominal CT

127

Treatment for Psoas Abscess

Surgical drainage and administration of an antibiotic regimen directed at the inciting organism
IF associated with pott's: m.TB
others: Staph, mixed organisms

128

Mechanisms of Gastrointestinal Pathogens Cansing diarrhea

Non Inflammatory (enterotoxin)
Inflammatory ( invasion or cytotoxin)
Penetrating

129

Non inflammatory diarrhea usually presents with usterry diarrhea and affects what part of the colon

Proximal Small bowel

130

Enteric fever has what mechanisms of diarrhea affecting the distal colon

Penetrating

131

Cause watery diarrhea by acting directly on secretory mechanisms in the intestinal mucosa

Enterotoxin

132

Causes destruction of mucosal cells and produce dysentery syndrome, with bloody Stools containing Inflammqtory Cells

Cytotoxin

133

Cytotoxin producing enteric pathogens:

Shigella dysenteriae type 1( hemorrhagic colitis)
v. parahaemolYticus
Clostridium difficille
Shigq toxin_ producing strains of E .co li ( HUS)

134

Predominant cause of Nosocomial diarrhea in adults

C. Difficile

135

Considered if with history and stool exam indicating a non inflammatory etiology of diarrhea and there is evidence Of a common - outbreak

Bacterial food Poisoning

136

Associated with contaminated fried rice due to germination of Spore when cooked rice is not refrigerated

Emetic form of Bacillus cereus

137

Diarrhea with slightly longer duration( 8-14 H) results from the survival of heat resistant spores in inadequately cooked meat, poultry or legumes

Clostridium perfringens

138

Culture media For cholera

TCBS agar

139

culture media For Shigella and Salmonella

Mac (onkey agar

140

Inexpensive agent for prophylaxis of travelers diarrhea

Bismuth subsalicylate

141

Resistance of TB bacilli to at least Rifampicin and Isoniazid

MDR- T B

142

Resistance to INH -R- FQ+ One Iv aminoglycoside

XDR-TB

143

most common mode or transmission of TB

Aerosolized droplet

144

Most likely to transmit PTB

(+) Sputum AFB by microscopy
cavitary PTB
laryngeal PTB

145

Non infectiouS TB

culture negative TB and extrapulmonary TB

146

Encodes for catalase/ peroxidase enzyme to protect against Oxidative stress required nor isoniazid activation and subsequent bactericidal activity

k at G

147

Encodes a key step in gly oxy late shunt that Facilitates bacterial growth on fatty acid substrate I required for Long term persistence of m. T B

Isocitrate lyase gene, icl1

148

control of r R NA transcription required for replication and persistence of the host all

car D gene

149

determine susceptibility to TB

NRAMP1(at chromosome 2q)

150

Delayed type hypersensitivity ( DTH) reaction to various bacillary antigens, can destroy un activated macrophages that contain multiplying bacilli and cause caseons necrosis

Tissue damaging response

151

T. cell- mediated phenomenon resulting in activation of macrophages that are capable of killing and digesting tubercle bacilli

macrophage activating response

152

Lymphocytes and activated macrophages evolve to epithelioid and giant cell

Granulomatous lesions ( tubercles)

153

Bacilli remain active forming biofilms in necrotic areas where they temporarily hide

latency

154

Healed lesions in lung parenchyma and hilar Lymph nodes may Later undergo calcification

Ranke complex

155

confers partial immunity against m. tuberculosis

Cell- mediated immunity

156

complication characterized by rupture of dilated vessel in a cavity leading to massive hemoptysis

Rasmussen's aneurysm

157

most common presentation of extrapulmonary TB

TB lymphadenitis

158

Gold standard for Diagnosis OfTB meningitis

CSF culture

159

uncommon manifestation of TB, presents as One or more SOL and usually causes seizure and focal signs

Tuberculoma

160

Most common sites affected by GI TB

terminal ileum and cecum

161

Pathognomonic of military TB

choroidal tubercles( 30 % 0f cases)

162

chronic pulmonary Aspergillosis as a complication of PTB is treated with

Itraconazole 6 months

163

Measure of variability, number AFBin skin scrapings that stain uniformly bright in leprosy patients

morphologic Index

164

A logarithmic scaled measure of the density of M. leprae in the dermis

Bacteriologic Index
4+ to 6+ in untreated patients and decreases with effective therapy

165

Relapse or drug resistance in Leprosy patients is indicated by

Increasing Bacteriologic ald morphologic index

166

key component in the cell membrane of M. leprae

Lipoarabinomannan

167

Less severe end of the spectrum Of leprosy with symptoms usually confined to the skin and peripheral nerves
may present with out nerve trunk involvement with no skin lesions ( neural leprosy)
Lepromin test positive

Tuberculoid leprosy

168

More severe end Of the Leprosy spectrum
characteristic Leonine facies
Negative Lepromin test

Lepromatons leprosy

169

Most commonly affected nerve trunk in Leprosy

Ulnar nerve
NOTE: median nerve: impairs thumb opposition and grasp
radial nerve: Rare in leprosy leads to wrist drop

170

Partial or complete Footdrop in leprosy

peroneal Nerve palsy

171

Treatment for Leprosy

CRD
clofazimine
Rifampin
Dapsone

Rifampin is the only bactericidal
Dapsone ( Folate antagonist) Sulfones: mainstay therapy
> causes severe he momsis in G 6 P D deficient individuals
Clofaziomine causes red black skin discoloration

172

Classification of leprosy based on number of Skin lesions ( WHO)

Paucibacillary < 5 lesions
multibacillary >/= 5 lesions

173

Classification of leprosy based on number of Skin lesions ( WHO)

Paucibacillary < 5 lesions
multibacillary >/= 5 lesions

174

Associated with aspirin given to patients with influenza b infection

Reye's syndrome

175

Treatment for refractory arthritis in Chikungunya

Chloroquine

176

Characteristic pathologic CNS finding in rabies

Cytoplasmic inclusions - Negri bodies

177

Two acute neurologic forms of rabies in humans

1. Encephalitic (80%)
2. Paralytic (20%)

178

Six genus of plasmodium causing malarial infections in humans

P. Malaria
P. Falciparum
P. Vivax
P. Ovale (2 morphologically identical sympatric species)
P. Knowlesi

179

Pathogenesis of malaria

Due to direct effects of rbc invasion and destruction by the asexual parasite and the hosts reaction

180

In patient infected with malaria when do symptoms occur

When merozoites are released into the bloodstream reaching densities of 50/ul of blood (100M parasites in the blood of an adult)

181

Responsible for relapses in p. Vivax and ovale

Hypnozoites

Remains dormant in the liver for 3 weeks to a year

182

When merozoites invade rbcs the become

Trophozoites multiplying 6-20 fold every 48-72H

183

At the end of the intraerythrocytic stage the trophozoite nearly consumes 2/3 of the rbcs hgb and has grown to occupy thw cell

Schizont

184

Schizogony/merogony

Mult nuclear divisions, rbc ruptures to release 6-30 daughter merozoites capable of invading new rbcs to repeat the cycle

185

Transmission of malaria

Parasites develop morphologically distinct, longer lived SEXUAL forms (gametocytes) that can transmit malaria

186

Sporogony in malaria

When a biting female anopheline mosquito ingests a gametocyte and forms a zygote in its midgut which will later mature and produce sporozoites

187

Most common measure of malaria transmission rate

Entomologic inoculation rate

188

Fever spike patterns in malaria

Tertian every 2 days
Quartan every 3 days

189

Genetic disorder that confers protection against death from falciparum malaria

Sickle cell disease
Hemoglobin C and E
Hereditary ovalocytosis
Thalassemia
G6PD