IDS High Yield Figures Flashcards
1
Q
A
2
Q
What are the top risk factors with the highest relative risk/odds for developing active tuberculosis?
A
- Jejunoileal bypass (RR 30-60)
- Posttransplant period (renal, cardiac) (RR 20-70)
- Silicosis (RR 30)
- HIV infection (RR 21-30)
- IV drug use (RR 10-30)
- Chronic renal failure/hemodialysis (RR 10-25)
3
Q
What are other comorbidities and iatrogenic causes that increase TB risk?
A
- Diabetes (RR 2-4)
- Excessive alcohol use (RR 3)
- Immunosuppressive treatment (RR 10)
- Tumor necrosis factor-α inhibitors (RR 4-5)
- Gastrectomy (RR 2-5)
- Tobacco smoking (RR 2-3)
- Malnutrition and severe underweight (RR 2)
4
Q
What are the tuberculin reaction size cutoffs for TB preventive treatment?
A
- ≥5 mm: HIV-infected persons, recent TB contacts, organ transplant recipients, fibrotic lesions (old TB), immunosuppressed patients
- ≥10 mm: Recent immigrants (<5 years) from high-prevalence countries, injection drug users, mycobacteriology lab personnel, high-risk congregate settings (hospitals, shelters, correctional facilities), children <5 years exposed to high-risk adults
- ≥15 mm: Low-risk persons
5
Q
Who should receive TB preventive treatment at a TST cutoff of ≥5 mm?
A
- HIV-infected persons
- Recent contacts of TB patients
- Organ transplant recipients
- Persons with fibrotic lesions on chest X-ray
- Persons on immunosuppressive therapy (glucocorticoids, TNF-α inhibitors)
6
Q
Who should receive TB preventive treatment at a TST cutoff of ≥10 mm?
A
- Recent immigrants (≤5 years) from high-prevalence countries
- Injection drug users
- Mycobacteriology lab personnel
- Residents and employees of high-risk congregate settings (hospitals, shelters, correctional facilities)
- Children <5 years and adolescents exposed to adults in high-risk categories
7
Q
Who should receive TB preventive treatment at a TST cutoff of ≥15 mm?
A
- Low-risk persons (TST is not indicated except in specific employment screening)
8
Q
Tuberculin (mm) reaction cut-offs
A
9
Q
indication for consult TB mac
A
10
Q
Antibiotic Therapy for enteric fever in adults
A
11
Q
Antibiotic therapy for Nontyphoidal salmonella infection in adults
A
12
Q
Preemptive treatment-
Antibiotic therapy for Nontyphoidal salmonella infection in adults
A
13
Q
Severe AGE
Antibiotic therapy for Nontyphoidal salmonella infection in adults
A
14
Q
Bacteremia
Antibiotic therapy for Nontyphoidal salmonella infection in adults
A
15
Q
Endocarditis or Arteritis- Antibiotic therapy for Nontyphoidal salmonella infection in adults
A
16
Q
Meningitis
Antibiotic therapy for Nontyphoidal salmonella infection in adults
A
17
Q
Other Localized Infection
A
18
Q
FUO approach
A
19
Q
Tx for Familial Mediteranean Fever?
A
Colchicine
20
Q
Tx for ADULT ONSET STILLS DISEASE?
A
NSAIDS
21
Q
Etiology of FUO: Pooled Results of Large STudies in the past 20 years (figure to memorize)
A
22
Q
Tx GIANT CELL ARTERITIS
A
Glucocorticoids
23
Q
clinical and pathologic progression of tetanus
A
24
Q
clinical and pathologic progression of tetanus 7-10 days
A
Tetanus toxin uptake in the NS, and VAMP cleavage in GAVA inhibitory neurons
Initial symptoms:
Muscle aches, trismus, myalgia
25
clinical and pathologic progression of tetanus 24-72 hours
FURTHER TOXIN effects
- muscle spasm; localized and generalized
- cardiovascular <3 instability; labile BP; tachy or bradycardia
Pyrexia- increased respiratory and GI secretions
26
clinical and pathologic progression of tetanus 4-6 weeks
TOXIN degradation
27
CSF abnormalities in Bacterial menigitis
OPENING pressure > 180mmH20
WBC 10-10,000u/L - neutrophilic pred
RBC - absent in non traumatic tab
Glucose LESS THAN 2.2/ 40mg/dl
CSF/serum glucose <0.4
Protein >0.45
GS Positive in > 60%
Culture positive in 80%
PCR detects bacterial DNA
28
Antibiotics used in empirical therapy of bacterial Menigitis and focal CNS infections?
29
Antibiotics used in empirical therapy of bacterial Menigitis and focal CNS infections - IMMUNOCOMPETENT CHILDREN >3months and ADULTS <55 years old
CEFOTAXIME /CEFTRI/CEFEPIME + VANCOMYCIN
CV!!!
30
Antibiotics used in empirical therapy of bacterial Menigitis and focal CNS infections?- adults >55 or any age with alcoholism or other delibitating illnesses
AMPICILLIN +
CEFOTAXIME/ /CEFTRI/CEFEPIME +
VANCOMYCIN
ACV!!! for adults >55 or any age with alcoholism or other delibitating illnesses
31
Antibiotics used in empirical therapy of bacterial Menigitis and focal CNS infections?
Ampicillin
CEFTAZIDIME or MEROP
VANCOMYCIN
A+Ceft/M+V
32
Total dosing of antimicrobial agents for bacterial meningitis
33
Characteristics of Plasmodium species infecting humans
34
Plasmodium specie that affects all cells
P. falciparum
BANANA SHAPED GAMETOCYTES AFFECTS ALL CELLS!!!!
35
Plasmodium specie/s with shuffners dots
P vivax and P ovale
36
Plasmodium specie/s affecting older red cells
P Malariae
37
Plasmodium specie/s affecting reticulocytes and cells up to 2 weeks old?
retic - P Vivax and ovale
retic and cells up to two weeks old= P vivax!
38
plasmodium specie/s affecting younger cells
Younger cells (but can invade all)- falciparum
younger cells - Knowlesi
39
Malaria transmission cycle (figure)
dormant form - hypnozoites
40
Identify blood film and species
Plasmodium falciparum
41
Identify blood film and species
Plasmodium vivax
42
Manifestations of severe falciparum
unarousable coma, acidemia/acidosis,
severe normo normo anemia
renal failure
pulmonary edema/ARDS
Hypoglycemia
Hypotension/shock
Bleeding/ DIC
Convulsions
43
Duke Criteria: Definitive IE?
* Duke Criteria: Definitive IE = 2 Major OR 1 Major + 3 Minor OR 5 Minor
44
WHO Rabies exposure categories and management
45
PEP for rabies vaccine schedule
* Intramuscular (IM) Schedule (Essen Regimen)
* Days: 0, 3, 7, 14 (previously 0, 3, 7, 14, 28)
* Intradermal (ID) Schedule (Updated WHO recommendation)
* 2-site ID regimen on Days 0, 3, 7 (faster immunity)
⚠️ Rabies Immunoglobulin (RIG) is required for Category III exposure.
* Infiltrate as much as possible into wound site.
* If insufficient volume, inject remaining IM (opposite limb from vaccine).
46
PrEP for vaccine schedule
* Pre-exposure prophylaxis (PrEP):
* Rabies vaccine on Days 0, 7, 21 or 28 (for high-risk individuals: veterinarians, travelers, researchers).
* Mass dog vaccination programs reduce human rabies cases.
* Control stray animal populations to prevent transmission.
47
Relative incidence of severe complications
48
Regimens for treatment of Malaria
49
CDC stage 3 (AIDS)- defining opportunistic illnesses in HIV infection
50
highest risk per exposure for HIV --parenteral
1. BLOOD TRANSFUSION
2. NEEDLE SHARING DURING
3. INJECTION DRUG USE
PERCUTANEOUS (Needle stick)
51
highest risk per exposure for HIV --SEXUAL
1- receptive anal intercourse
2 insertive anal
3. receptive penile - vagial
4. insertive penile- vaginal
5/ 6 receptive and insertive oral intercourse LOW!
52
Figure to memorize: Typical course of an untreated HIV infected individual
53
Serologic tests in the diagnosis of HIV 1 or HIV 2 infection
remember always to repeat after initial postivie screening and restest in 3-6 months if negative and clinically indicated!!
54
NIH CDC IDSA guidelines for the preventon off ooportunistic
55
Neurologic diseases in patients with HIV infection
56
Clinical findings in the acute HIV syndrome
57
Clinical feature of Pertussis per age group?
Cough Paroxysmal - most common in adults
Whoop- infants
58
Management of urethral discharge in men
59
usual causes of urethral discharge in men
Chlamydia trachomatis
neisseria gonorrhea
Mycoplasma genitalum
Ureaplasma urealyticum
Trichomonas vaginalis
Herpes Simplex virus
60
initial tx for patient and partners for urthral dischagre (Dx: Gonorrhea)
Ceftriaxone 500mg IM
61
Management of recurrence of urehtral dischagre in men
if patient was not re-exposed, consider infection with T. Vaginalis or antibitic resistant M. genitalium and treat
Metro - tricho
Axith - M genitalium
followed by Moxifloxacin if needed
62
Diagnostic features and management of vaginal infections
63
Vaginal infection?
Discharge: scanty white, clumped adherent plaques?
Treatment?
Vulvovaginal candidiasis
64
Vaginal infection?
SSx: Vulvar itching, profuse discharge
Discharge: Often profuse, white or yellow, homogenous
Treatment?
Trichomonal Vaginatis
Tx: Metronifazole or Tinidazole 2g single dose
or Metronidazole 500mg PO BID x 7 days
65
Vaginal infection?
Symptoms?Malodorous, sl. increased discharge
Discharge: Moderate, white or gray, homogenous low viscosisty, uniformly coats vaginal walls
Microscopy:
(+) clue cells
Treatment?
Bacterial Vaginosis
Metronifazole 500mg PO BID x 7 days
Metronidazole gel
Clinda cream
66
67
Initial management of genital or Perianal ulcer!
68
causative pathogens for genital or perianal ulcer?
HSV
Treponema pallidum (primary syphilis)
Haemophilus ducreyi (chancroid_
69
Factors associated with poor prognosis in ADULT tetanus!!!
MEMORIZE
Age >70 years
Incubation < 7 days
Short time from first symptom to admission
Puerperal IV, post surgery, burn entry site
Period of onset < 48 hours
Heart rate > 150 beats
SBP > 140
Severe disease or spasms
Temp >38.5C
70
EMpirical Antibiotic Treatment for hospital acquired/ ventilator associated pneumonia
**No risk factors; **
PIPTAZO 4.5g q6
Cefepime 2g q8
Levofloxacin 750mg IV q24
**If with risk factors**
1; PIPTAZO 4.5g q6
Cefepime 2g q8
Ceftazidime 2g q8
Imipinem 500mg q6
Meropenem 1g IV
+
2: Amikacin 15-20mg/kg IV q24
Gentamicin 5-7 mg/kg IV q 24
Tobramycin 5-7mg/kg IV q24h
Ciprofloxacin 400mg IV q8h
Levofloxacin 750mg yiv q24
Colistin
Polymyxin B
71
EMpirical Antibiotic Treatment for hospital acquired/ ventilator associated pneumonia for with RISK FACTORS FOR MRSA
add Linezolid 600mg TIV q12 or adjusted dose of VANCOMYCIN through level 15-20mg/dl
72
Pathogenic mechanisms and corresponding prevention strategies for VAP
73
Shistosomiasis and Food borne trematode infection treatment and doses!
74
Leptospirosis stages
(figure)
75
Mild leptospirosis treatment?
Doxycycline 100mg PO BID
Amoxicillin
Ampicillin
76
Moderate/severe leptospirosis tx?
Penicillin 1.5m IV or IM q6h or
Ceftriaxone 2g/day or
Cefotaxime 1g tiv q6h or Doxycycline 200mg LD then 100 q12
77
Leptospirosis post exposure
78
Leptospirosis severity table
79
Post exposure prophylaxis for individuals with a single history of wading in flood or contaminated water without wounds, cuts or open lesions of the skin?
LOW-RISK EXPOSURE is defined as those individuals with a single history of wading in flood or contaminated water without wounds, cuts or open lesions of the skin.
Doxycycline **200 mg single dose within 24 to 72 hours from exposure**
80
*post exposure prophylaxis* for **individuals with a single history of wading in flood or contaminated water and the presence of wounds, cuts, or open lesions of the skin, OR accidental ingestion of contaminated water.**
MODERATE-RISK EXPOSURE is defined as those individuals with a single history of wading in flood or contaminated water and the presence of wounds, cuts, or open lesions of the skin, OR accidental ingestion of contaminated water.
Doxycycline 200 mg once daily for 3-5 days to be started immediately within 24 to 72 hours from exposure
81
# p
post exposure prophylaxis for
**individuals with continuous exposure (those having more than a single exposure or several days such as those residing in flooded areas, rescuers and relief workers) of wading in flood or contaminated water with or without wounds, cuts or open lesions of the skin or Swimming in flooded waters especially in urban areas infested with domestic/sewer rats and ingestion of contaminated water**
HIGH-RISK EXPOSURE is defined as those individuals with continuous exposure (those having more than a single exposure or several days such as those residing in flooded areas, rescuers and relief workers) of wading in flood or contaminated water with or without wounds, cuts or open lesions of the skin. Swimming in flooded waters especially in urban areas infested with domestic/sewer rats and ingestion of contaminated water are also considered high risk exposures.
**Doxycycline 200 mg once weekly until the end of exposure**
82
initial antimicrobial therapy for severe sepsis with obvious source in aduls with normal renal function with Neutropenia <500
CEFEPIME+
MEROP or IMIP CILAS OR DORIPENEM +
PIPERACILLIN TAZOBACTAM
add Vanco if with central line assoicatied blood streeam infection
add tobra plus vanvo plus caspofungin one dose if withs evere sepsis/shock
83
Rabies algoithm for post exposure prophylaxis
(figure)
84
Dengue NS1 RDT is most useful in?
- symptoms within 3 days
- no previous hx of dengue infection
85
True or false?
among patients with suspected dengue infection, it is recommended to use Dengue NS1 IgM IgG rapid tests?
TRUE
86
Level of evidence for use of *Carica papaya* in DFS treatment
LOW
87
CPG low evidence and weak recommendations for DFS
88
Post diarrhea complications of acute infections diarrheal illness
89
causes of traveler's diarhea
90
etiologic agent of travelers' diarrhea that affects hikers who drink from freshwater streams
G. Lamblia
91
bacterial food poisoning etiology?
ate ham, poultyr, potato, egg salad, mayoinnaise, cream pastries
S. aureus
92
patient XY 20yo male, had nausea vomiting and diarhea after having fried rice
Dx?
bacterial food poisoning - Bacillus cereus
93
watery diarrhea after eating shellfish
Vibrio cholerae
94
95
watery diarrhea after eating salads, cheese, meats
Makes up 10-45% of cases of travelers diarrhea
ETEC
96
emerging enteric pathogen for traveler's diarrhea
EnteroAggrevative E. Coli
97
dysentery + Mollusks and crustacheans
vibrio parahaemolyticus
98
dysentery after eating potato egg salad
Shigella spp
99
infalamattory diarrhea after eating beef, pilutlry eggs, dairy
Salmonella
100
bloody diarrhea after eating ground beef, roast beef, salami, raw milk, raw vegetables, apple juice
EHEC
101
