Inf Dz Flashcards
(216 cards)
1
Q
abx ladder for gram (+) coverage
A
PCNs –> naficillin –> Vanco –> Linezolid
2
Q
abx ladder for gram (-) coverage
A
PCNs –> ampicillin/amoxicillin ( + beta lactamase - gives some gram (+) coverage) –> pipicercillin ( + tazobactam gives some gram (+) coverage) –> carbapenams
3
Q
generations of cephalosporins
A
1st gen - gram + coverage
2nd gen - gram + coverage
3rd gen - gram (-) coverage
4th gen - gram (-) coverage and some gram (+) coverage
4
Q
fluoroquinolones
A
1st - cipro
2nd - levofloxacin
3rd - moxifloxacin
each generation contains prior generation benefits
5
Q
anaerobic coverage
A
metro - groin and abdomen
clindamycin - everywhere else
6
Q
abx coverage of CAP
A
ceftriaxone + azithromycin (IV) or moxifloxacin (oral or IV) or azithromycin (oral)
7
Q
abx coverage of health care association pna
A
vancomycin
+
pip/tazo
8
Q
abx coverage of meningitis
A
ceftriaxone \+ vancomycin \+/- steroids (M3 level everyone) \+/- ampicillin (if immunocompromised)
9
Q
abx coverage of UTI
A
amoxicillin (pregnant) or nitrofuranotin (female) or TMP-SMX or Ceftriaxone (inpatient pyelo tx) or Cipro (ambulatory pyelo)
10
Q
basic tx of HIV
A
antiretrovirals 2+ 1
2 - NRTs - emtricitabine + tenofovir
+
1 - either NNRT, PI + ritonavir, entry inhibitors, fusion inhibitors
11
Q
pre exposure prophylaxis
A
2 NRTs
- emtricitabine + tenofovir
12
Q
post exposure prophylaxis
A
2 NRTs + 1
- emtricitabine + tenofovir (+/-) raltegravir (PI)
13
Q
pregnancy
A
AZT
to prevent vertical transmission
14
Q
risk factors of HIV
A
sex (0.2%)
IV drug use and needle sticks (0.3%)
vertical transmission (25%)
15
Q
antiretroviral syndrome
A
acute HIV infection
“flu like symptoms”
dx - PCR (elisa is too soon here)
16
Q
dx of HIV
A
ELISA –> confirmatory test = western blot –> tell pt now —–> run viral load + CD4 + genotype (shows sensitivity to meds)
17
Q
CD4 counts bugs emperic abx
A
CD4 count bugs abx
<200 PCP TMP-SMX or dapsone or atovaquone
(if G6PD)
<100 . toxo TMP-SMX - propymethramine + leucovorin
<50 MAC . weekly azithromycin
18
Q
primary TB infection
A
lobar pneumonia that just doesn’t get better
cavitations - casseating granulomas
19
Q
secondary TB infection (reactivation)
A
ghon complex
apical lesions - low O2 tension
hemopytsis, night sweats, weight loss
20
Q
asymptomatic screening
A
TB test –> PPD or quantiferon assay –> + –> CXR –> + AFB smear –> + –> activation TB –> RIPE
21
Q
PPD readings that are positive
A
> 5mm - if immunocompromised
10mm - if health care worker, travel to endemic areas, prison, homeless
15mm - soccer mom
22
Q
TB tx for latent infection and active infection
A
latent TB - INH + B6
active TB - RIPE
R - rifampin - ADR - red body fluids
I - INH - ADR - peripheral neuropathy give B6
P - Pyrazinamide - ADR - hyperuricemia, gout
E - ethambutol - ADR - red green colorblindness
23
Q
pt with history of BCG vaccine
PPD or interferon gamma assay
A
interferon gamma assay
24
Q
+PPD and (-) CXR –>
A
INH + B6
25
most sensitive and specific TB test =
NAAT
PCR
adenosine deaminase for bodily fluid testing
26
SIRS (systemic inflammatory response syndrome) criteria
Temp >38 or <36
WBC > 12 or < 4
HR > 90
RR > 20
27
Sepsis severity
SIRS - if 2/4 (+)
Septic - if SIRS + and source present
Severe sepsis >1 organ dysfunction - that responds to fluid
(vs)
Septic Shock >1 organ dysfunction - that does not respond to fluid - needs pressors
MOD - multi organ dysfunction >2 organ dysfunction
28
Goals of tx of sepsis
central venous pressure 10-12
urine output > 0.5cc/kg/hr
MAP >65
Centreal venous oxygen sat > 70%
29
therapy for sepsis
abx
fluids 2-3L
remove source - foley, central line, ET tube, abscess, etc
vasopressors if needed
30
organs affected by sepsis
```
heart - hypotension
brain - AMS
kidney - increased BUN/Cr
Liver - increased LFTs
Lungs - ARDS
```
31
safe to do an LP or not
```
if any + cant do LP --> do CT if (-) --> LP
F - FND
A- AMS
I- immunocompromised
L - local lesion impeding LP
S- seizures
```
32
not typical bacterial causes of Meningitis
```
Crypto
Rocky Mountain Spotted Fever
Lyme Disease
TB
Syphillis
```
33
crypto meningitis
AIDs pt with fever and HA
>20cm opening pressure
crypto antigen >>> india ink
tx - amphotercin
34
Rocky Mountain spotted fever meningitis
fever
rash from arms to trunks
tick bites
camping
ab on CSF
tx - ceftriaxone
35
lyme dz meningitis
connecticut
targetoid rash with arhralgias
arrhythmias
lyme ab
tx - ceftriaxone
36
TB meningitis
night sweats weight loss hemoptysis
homeless prison
endemic area
tx - RIPE
37
Mass lesion found on non con CT head -->
HIV/AIDs -> yes -> Toxo ab -> yes -> toxo tx -> rescan in 6wks to see if lesion gone
(if lesion still there go to biopsy
if no to toxo ab or HIV/AIDs --> brain biopsy
- brain abscess -> drain/abx
- cancer -> chemo/radiation
38
LP showing predominantly lymphocytes --> encephalitis ->
HSV - temporal lobs and hemorrhagic LP
HSV PCR --> + --> tx HCV --> acyclovir
HSV PCR --> (-) --> other causes - st louis, quine, west nile etc --> supportive tx
39
LP needed but meets FAILS criteria next step
give emperic abx --> CT scan --> if no lesion seen --> LP good to go
40
cellulitis path
staph aureus (likes to form abscesses)
strep group A (no abscesses)
41
presentation of cellulitis
```
red
hot
tender
well demarcated
site of entry
```
42
dx of cellulitis - clinical
| tx of cellulitis -
non toxic
- staph - oral TMP-SMX or clinda
- strep - 1st gen cephalosporin
Toxic
- staph - vanc, linezolid, or clinda (IV)
- strep - Pip/Tazo and ampicilli/ calvulanate
43
tx of cellulitis if diabetic
vanc and pip/tazo
44
path of osteomyeltis
infection of bone
| hematogenous or direct innoculation via a penetrating injury
45
pt presentation of osteomyelitis
wound - probe bone
sinus draining tracts
recurrent or refractory cellulitis
46
dx of osteomyelitis
1st x-ray (+after 2wks) --> if (-) --> MRI (best test)
bone scan okay if no cellulitis present
biopsy is great gets specific bug
47
tx of osteomyelitis
debridment
4-6wk (vanc and pip/tazo)
follow up with ESR and CRP
48
Gas gangrene path
clostridium perfinges
49
gas gangrene presentation
penetrating wound that got contaminated
| crepitus present
50
dx of gas gangrene
x-ray shows you gas
51
tx of gas gangrene
debridment
| PCN and clindamycin (ribosome 50s - blocks toxin production)
52
necrotizing fascitis path
staph and strep
if in groin called fournier gangrene
53
presentation of nec fasc
cellulitis and ......
- toxic person
- pain out of proportion to the physical exam
- blue/gray discoloration
- rapidly spreading
- crepitus
54
dx of nec fas
x-ray shows gas --> immediate debridment which includes biopsy
55
tx of nec fas
immediate debridment --> get biopsy
3rd gen cephalosporin + clinda + ampicillin
56
MCC of osteomyletis
staph auerus
57
Sickle cell pt and staph not on option
salmonella
58
penetrating wound and sneaker involved in osteomyeltis
| cause
pseudomonas
59
diabetic with osteomyeltits
pseudomonas
60
oyster consumption in cirrhotic
vibrio vulnificus
61
gardening osteomyeltis
sporotrichix
62
CAP vs HCAP (HAP)
-CAP
>90 days from med building
<48 hrs admission
-HCAP
<90 days from med building
>48hrs admission
63
CAP Bugs
Strep Pna - MCC
Moraxella Catarhalis
H Influenza - COPD
Klebsiella (aspiration/etoh/AMS)
```
Staph Auerus (postviral)
Legionella (immunosuppressed, smoker)
```
64
tx of CAP
```
3rd gen cephalosporin
+
Macrolide
or
Moxifloxacin
```
65
HAP = HCAP bugs
pseudomonas
| MRSA
66
HCAP tx
pip/tazo
| vancomycin
67
immunosuppressed and PNA bugs
TB
Fungal
PCP
68
influenza PNA
fever cough myalgias
dx - nasopharyngeal swab or BAL
tx - oseltamavir - prevent with vaccine
69
ED
| PNA - admit or nah?
```
CURB-65
C - confusion
U - bUn >19
R - rr >30
B - blood pressure - sys <90, dias <60
65 - >65 y/o
```
70
Fever and cough work up
CXR
- > (-) --> bronchitis --> oral abx
- > cavitary lesion -> CT scan -> fungus/TB/abscess
- > (+) consolidation -> PNA -> building and time?
71
bronchitis tx
```
oral abx
macrolide (azithromycin)
or
doxycyline
or
moxifloxacin
```
72
lung absces tx
DONT DRAIN
3rd gen cephalosporin
+
clindamycin
73
PNA in an HIV/AIDs
patchy bibasilar infiltrates
CD4 <200
dx - sputum silver stain
tx - TMP-SMX
----> if hypoxemic or low PaO2 give steroids
74
abx duration for uti to pyelo
uncomplicated cystitis - 3days
complicated cystitis - 7days
pyelonephritis - 10days
perinephric abscess -14days
75
bugs in urinary infections
E coli 80%
klebsiella
proteus
76
risk factors for UTIs
18-25 year old females on contraception having sex
females = shorter urethrea
men -anal sex
77
diagnosing UTIs
UA: (+) if leukocyte esterase, nitrites, >10 wbcs/hpf
urine culture: if pt preg, urological procedure, 10^5 CFU, abx sensitivities
CT scan - non preg pts
US - preg pts
78
complicated cystitis
uncomplicated = non preg female
```
P's
penis - male
plastic - catheters, foleys
procedures - urological
Pyelo
```
79
urethritis
STD - gonorrhea, chlamydia
discharge
dx - swab/urine test
80
tx of urethritis
```
ceftriaxone 250mg x1 IM
+
azithromycin po x1
or
doxycycline po daily x7days
```
f/u - hiv screen
81
asymptomatic bacteruria screen
preg female or urologic procedures
path - gram neg rods and group B strep
tx - preg - amoxcillin (if PCN allergy nitrofurantoin)
repeat screen in f/u
82
cystitis
path - gram - rods
urgency, frequency, dysuria, young female
dx - U/A
83
tx of cystitis
empiric - TMP-SMX (unless CKD) or nitrofurantoin or fosfomycin
complicated 7 days
uncomplicated 3 days
84
pyelonephritis
path - gnr
urgency frequency dysuria fever chills CVAT
dx - U/A - wbc casts -> urine culture
85
tx of pyelonephritis
IV - ceftriaxone - hospitalized -> see if abscess is present -> if no improvement in <72hrs --> CT scan or US (if preg)
IV cipro --> Po cipro (ambulatory pyelo)
10days in duration
86
tx of nephritic abscess
14 days of IV ceftriaxone
87
ulcer work up -->
of ulcers
is there pain?
lymphadenopathy present?
88
types of genital ulcers
syphillis
lymphogranulomvenerum
chancroid
herpes
89
Syphillis
| path and pt presentation
path - trep pallidum
1 - painless singular ulcer and non tender LAD
2 - fever and rash, targetoid rash - palms and soles
3 - neurosyphillis, tabes dorsalis (DCLMS), argyll roberston pupil
90
Dx of Syphillis
1 - darkfield microscopy
2- RPR + --> FTA -abs trep
3 - LP --> RPR on CSF --> FTA-ABs on CSF
91
Tx of Syphillis
1 - PCN x1 IM
2 - PCN x1 IM
Early latent (exposure <1yr) - PCN x1 IM
```
3 - PCN IV Q4 hr 10-14 days
Late latent (exposure >1yr) - PCN IM weekly x3 weeks
```
92
Lymphogranulomvenerum
path - C Trachamotasis
painless singular ulcer
(+) tender Lymph Nodes - suppurative and draining
dx - NAAT
tx - doxycycline
93
Chancroid
path - Haemophils Ducreyi
Painful single ulcer with tender Lymph Nodes
dx - gram stain and culture
tx - azithromycin or cipro
94
Herpes
path - HSV1 or HSV2
painful burning prodrome
painful ulcers - vesicles on erythematous base, (coalesce into an ulcer shape)
dx - PCR
tx- Acyclovir or Valacyclovir
95
RPR measurements
1:3
1:3000
the bigger the 2nd number the worse the dz
96
otitis media path
URI bugs - strep pna, moraxella catarhalis, H influenza
| middle ear - TM
97
otitis media presentation
Unilateral Ear Pain - relieved by puling on pinna
bulging erythematous TM
loss of light reflux
fluid behind ear
98
Otitis Media Dx
pneumatic insuflation - TM rigid = (+)
99
tx of Otitis Media
1st line - amoxicillin
recur - amox + clavulanate
recur 3/6 or 4/12 --> tymphanoplasty
PCN allergy - non life threatening - Cefidinir
PCN allergy - life threatening - Azithromycin
100
Otitis Externa
path - outer ear - pinna canal
Swimmers ear - Pseudomonas
Digital trauma - Staph Aureus
101
Otitis Externa presentation
unilateral ear pain - made worse puling pinna
| outer canal is erythematous - no bulging TM
102
dx and tx of Otitis externa
dx - clinical
tx - spontaneously resolves
if toxic ----> abx - Cipro drops + steroids
103
Complication of otitis exertna
Mastoiditis
104
Mastoiditis
path - URI bugs - ppl with ear tubes
loos like AOM + swelling behind ear, anterior rotation of ear
dx - clinical
tx - surgical decompression
105
Sinusitis path and presentation
path - URI Bugs - strep pna
congestion
bilateral purulent discharge - thick and white smelly
facial tap = painful
106
Sinusitis
| dx and tx
airfluid levels -xray opacification - CT
dx - clinical
tx - supportive unless:
--> temp >38
--> >10days
--> worsening
(if any (+) ----> PCN - amox + clavulanate)
107
recurrent sinusitis -->
CT scan to see if anatomical abnormality
108
Cold "nasal viral"
path - rhinovirus, air droplets
congestion, bilateral clear discharge, rhinorrhea-copius
tx - supportive
109
Pharyngitis
path - viral, group A strep
```
sore throat, odynophagia
C - no cough
E - exudates
N - nodes
T - temp >38
OR: <14 = +1
>44 = (-1)
```
110
pharyngitis tx
amoxicillin + clavulanate
111
major criteria in IE
bacteremia
new regurgitation murmur
Echo - vegetation
112
Minor criteria in IE
Risk Factors - IV drug abuse, prosethetic valves, hx of endocarditis
Fever - >38
Vascular - septic emboli, embolic CVA, Acute Limb ischemia, Splinter hemorrhage - nail beds, janeway lesions painless
rheumatological - roth spots, osler nodes (painful) glomerulonephritis
113
Acute IE
| aggressive
path - staph auerus and strep pneumoniae
CHF presentation, bacteremia, toxic, no time = (-) rheum symptoms
Give empiric abx until blood cultures are (-)
114
Subacute IE
| indolent
path - HACEK
fever on and off, nontoxic, (+) rheum symptoms enough time
blood cultures then if (+) --> empiric abx
115
tx of acute IE
native valve --> Vancomycin
prosthetic valve <60 --> vanc +gent + cefepime
prosthetic valve 60-365 --> vanc + gent
Prosthetic valve >365 --> vanc +gent + ceftriaxone
116
tx of subacute IE
gent + ceftriaxone
117
Surgical indications for IE
CHF
vegetations >15mm
Vegetations >10mm and embolization
abscess/fungus - abx wont work
118
prophylaxis tx for IE
when bad valve or dental oral procedure
amoxicillin = tx choice
119
dx test of choice of IE
TEE
120
multilobular consolidation indicates
severe pneumonia
121
a normal pulse in the setting of a high fever is suggestive
of atypical CP pneumonia
pulse-temp dissociation
122
what PNA bug associated with nursing home residents
pseudomonas
123
Ventilatory associated PNA RF
increased risk due to not being able to cough
decreased mucociliary clearance
dx - new infiltrate on CXR - purulent secretions from ET tube, fever and increasing WBC
124
tx of ventilator associated pna
```
cephalosporin (ceftazidine or Cefepime)
+
aminoglycoside
+
vancomycin or Linezolid
```
125
lung abscess pearls
posterior segments of upper lobes
superior segments of lower lobes
right lobe
126
lung abscess CXR
air fluid levels
| thick walled cavitations
127
TB transmission
aerosolized droplets from someone with ACTIVE TB
128
secondary TB reactivation
```
common in immunocompromised hosts
HIV
Malignancy
Immunosuppressants
substance abuse
poor nutrition
```
129
risk factors for TB
```
HIV +
prisoners
health care workers
diabetes
close contact
alcoholics
glucocorticoid use
IV drug use
hematologic malignancy
```
130
symptoms of primary secondary TB
primary - asymptomatic - ghon complex
| secondary - fever night sweats, weight loss, malaise
131
ghon complex
calcified primary focus with an associated lymph node
ranke complex = ghon complex that undergoes fibrosis and calcification
132
tx of TB
RIPE for 2 months --> INH and Rifampin for 4 months
133
influenza
| epidemics vs pandemics
epidemics - common - due to minor genetic reassortment
pandemics - rare - due to major genetic recombination
134
TB meds and hepatotoxicity
all meds cause it
| dont discontinue unless 3 to 5x upper limits of nml
135
complications of meningitis
seizures
coma
brain abscesses
subdural empyema
deafness, brain damage, hydrocephalus
136
CSF profile of bacterial meningitis
increased WBC - PMNs predominate
Low glucose
High protein
137
viral causes of Meningitis
herpes (HSV-1)
arbovirus - eastern equine encephalitis, west nile virus
Enterovirus - polio
138
non viral infectious causes of meningitis
toxoplasmosis
| cerebral aspergillosis
139
non infectious causes of meningitis
metabolic encephalopathies
| T cell lymphoma
140
risk factors for encephalitis
```
AIDs - CD4 <200 - think toxo
Immunosuppression
Travel to underdeveloped countries
mosquitos (endemic areas)
Bats
```
141
nonbacterial causes of brain abscesses
toxo and fungi in aids pts
candida spp, aspergillosis, zingomycosis (neutropenic pts)
142
Hep B associations
| Hep C associations
Hep B - PAN
| Hep C - Cryptoglobulinemia
143
transmission of Hepatitis
Hep A and E - fecal oral
Hep B - drugs and sex
Hep C - drugs
144
causes of transaminases >500
acute hepatitis - viral
shock liver
drug induced hepatitis
145
fulminant hepatitis
severe complication of hepatitis
| liver failure - life threatening
146
other complications of hepatitis
hepatic encephalopathy - asterexis and palmar erythema
hepatorenal syndrome - venous thrombosis
bleeding diathesis - only when liver function is severe
147
Tx of hepaititis
Hep B
Hep C
hep B - IFN alpha or Lamivudine
Hep C - IFN alpha and ribavirin
148
most frequent indication for liver transplant in the US
HCV
149
presentation of botulinism
symmetric descending flaccid paralysis --> starting with dry mouth, diplopia, and/or dysarthria, --> paralysis of limb musculature
150
causes of intrabdominal abscesses
```
spontaneous bacterial peritonintis
pelvic infections tuboovarian abscesses
pancreatitis*
gi tract perf *
osteomyelitis of vertebral bodies
```
151
non infectious causes of cystitis
cytotoxic agents - cyclophosamide
radiation to pelvis
dysfunctional voiding
interstitial cystitis
152
when to obtain a urine culture
>65 y/o
DM
recurrent UTIs
>7 days with symptoms
use of diaphragm as contraception device
153
when do you tx asymptomatic bacteruria
pregnant
| before having a urological procedure
154
risk factors for upper UTI
pregnancy
diabetes
VUR
155
tx of dysuria specifically
pyridium (phenazopyrdime) - urinary analgesic - 1-3 days
156
acute prostatis
fever
tender prostate
boggy prostate
younger men
due to ascending infection from urethra
157
chronic prostatis
well appearing
nml prostate just large
recurrent UTIs
158
chlamydia is a risk factor for
cervical cancer
159
leading cause of infertility in women
due to chlamydia infections that lead to tubal scarring
160
C-section in HIV women
indicated if viral load >1,000
161
if viral load is >50 after 4 months of tx for HIV
change regiment
162
gold standard for dx of HSV
culture
tzanck smear = quickest
163
Chancroid
haemophilus ducreyi
painful raw ragged borders beefy red
tx - azithro
164
causes of false (+) RPR or VDRL
SLE
antiphospholipid syndrome
Lyme dz
165
lymphogranuloma venereum
C trachomatis
painless ulcer
tender inguinal lymphadenopahty (Unilateral)
tx - doxy
166
causes of cellulitis with exposure to water
pseudomonas
| vibrio vulnificus
167
Predisposing factors to erysipelas
```
lympahtic obstruction
radical mastectomy
local trauma
abscess, fungal infections
DM
alcoholism
```
168
risk factors for necrotizing fascitis
surgery
diabetes
trauma
IV drug use
169
bugs that cause of necrotizing fascitis
strep pyogenes
| clostridium perferenges
170
pathophys of tetanus
causes by neurotoxins produced by spores
exotoxin blocks inhibitory transmitters at the NMJ
171
tetanus managment
give diazepam for tetani
IM tetanus IG (TIG)
172
tetanus wound management
< 3doses of Td or >10yrs
- clean - Td
- dirty - Td + TIG
> 2 doses of Td
- clean - nothing
- dirty - nothing
173
bugs for osteomyletis
- catheter
- prosthetic joint
- diabetic foot ulcer
- nosocomial infections
- IV drug use or neutropenia
- Sickle cell -
- catheter - staph
- prosthetic joint - coagulase neg staph
- diabetic foot ulcer - polymicrobial
- nosocomial infections - pseudomonas
- IV drug use or neutropenia - fungal
- Sickle cell - salmonella
174
pott disease
osteomyeltis of the vertebral bodies due to M tuberculosis
175
clinical findings of osteomyelitis
pain over the involved area of bone
localized erythema or swelling
some systemic symptoms
draining sinus tract - chronic issue
176
for osteomyelitis how do monitor response to tx
ESR and CRP
177
dx test of choice for osteomyelitis
MRI
178
Gonococcal arthritis
presents with acute monoarthritis
progresses within days in a migratory or additive pattern
tenosynovitis is present in the hands and feets
179
complications of septic arthritis
destruction of joint and surrounding structures (ligaments, tendons) --> stiffness and pain and LOF
```
avascular necrosis (hip)
sepsis
```
180
Clinical features of rocky mountain spotted fever
sudden onset of fever, chills, malaise, N/V
rash - appears after 4-5 days of fever
- starts on peripherally --> centrally
- papular --> maculopapular --> petechial
tx - doxy
181
fever patterns of malaria
falciparum - constant - worst one
ovale and vivax - q48hrs
malariae - q72hrs
182
tx of malaria
chloroquine if not resistant
| if resistant - quinine sulfate + tetracyclines
183
prophylaxis for malaria
mefloquine if chloroquine resistance
184
ADR of malaria meds
atovaquone
mefloquine
chloroquine - benefit
primaquine
atovaquine - C/I - preg and renal dz
mefloquine - C/I - sz and psych
chloroquine - good in preg
primaquine - C/I - G6PD def ---> HA
185
Leptosporosis
contaminated water
reservoir - rodents, farm animals
rash, LAD, increased LFTs
renal and/or liver failure
vasculitis, vascular collapse
tx - oral abx - tetracycline or doxycycline if severe IV PCN G
186
Q Fever
farm animals
acute - constitutional symptoms N/V
chronic - endocarditis
CXR - multiple opacities in acute illness
tx - acute - doxy and chronic - rifampin
187
Cat scratch disease
bartonella henselae
serology
LAN or lymphadenitis
Tx - self limiting,
severe doxy or cipro
188
cutaneous candidiasis
erythematous eroded patches with satellite lesions
more common in obese diabetics pts
appears in skin folds, underneath breasts and in macerated skin
189
allergic bronchopulmonary aspergillosis
type I HSR
asthma and eosinophilia
avoid exposure and corticosteroids
190
pulmonary asperigiloma
inhalation of spores into the lungs
RF - hx of sarcoidosis, histo, TB and bronchiectasis
tx - pts with massive hemopytsis may need lobectomy
191
invasive aspergillosis
immunocompromised pts
(+) fever, resp distress, despite use of broad spectrum abx
hyphae invade lung vasculature -> thrombosis and infarct
bilateral pulm infiltrates
192
tx of invasive aspergillosis
IV amphotercin B
193
cryptococcosis neoformans
dx
tx
dx - latex agglutination, india ink smear - encapsulated yeasts, biopsy - lack of inflammatory response
tx - amphotercin B + flucytosine --> fluconazole
194
causes of hyperthermia
neuroleptic malignant syndrome
malignant hyperthermia
heat stroke
195
hyperthemia
responds to
doesnt respond to
doesnt respond to antipyertics
does respond to external cooling measures
196
Toxic shock syndrome risk factors
menstruating women with tampons
| surgical wounds, burns and infected insect bites
197
toxic shock syndrome caused by
enterotoxin of staph aureus or group A strep (rare)
198
clinical features of TSS
abrupt
flu like
diffuse macular erthematous rash - desquamates over palms and soles
strawberry tongue
hypotension
199
tx of TSS
hemodynamic stabilization --> remove source, drain and debride wounds --> give anti staph abx (naficillin, oxacillin, vanc)
200
MCC of catheter related sepsis
central lines
| increased risk with emergent placement, femoral lines, indwelling of the line
201
bugs of catheter related sepsis
staph aureus
| staph epidermidis
202
neutropenia def
ANC < 1,500
| ANC <500 --> severe infection risk
203
causes of MONO
EBV mainly (CMV - rare)
204
CMV mono
sexually active young adults
(-) cervical adenopathy
(-) pharyngitis
(-) heterophile abs
205
complications of mono
bells palsy
206
blastomycosis basics
| dimorphic fungi
inhaltion of spores
chronic indolent - constitutional symptoms, LAN, PNA
tx - itraconazole
207
histo basics
| dimorhphic fungus with septate hyphae
exposure to bird/bat shit
ohio and mississippi valleys
flu like, erythema nodosum, hepatosplenomegaly
tx - itraconazole
208
coccidiomycosis
| dimorhic fungi
inhalation of spores
asymptomatic
dissemination -> CNS issues
tx - fluconazole
209
sporotrichosis
| dimorhphic - cigar shaped yeast
invasion of skin via thorn - gardening
lymphocutaneous form - hard sub q nodules - > ulcerate and drain
disseminated .-> pna and meningitis
tx - potassium iodide x itraconazole
210
cryptosporidiosis
| spore forming protozoa
fecal oral
watery diarrhea - immunocompromised
oocytes
tx - supportive
211
amebiasis
entamoeba histolytica
fecal oral, contaminated water/food/ anal oral sex
bloody diarrhea, tenesmus, abd pain +/- liver abscess
trophozoites
tx - metro for liver
212
giardiasis
fecal oral, daycare camping
watery diarrhea, chronic infection, weight loss
trophozoites or cysts
tx - metro
213
ascariasis
| round worm
ingestion of food or water contaminated by human feces
postprandial abd pain, vomiting, heavy worm burden
pancreatic duct, common bile duct obstruction
eggs or adult worms
tx - albendazole, mebendazole, or pyrantel pamoate
214
hookworm
| necator americanus
larvae invade skin - travel to lung - cough and swallow -> intestine
cough, anemia, malabsorption, weight loss, eosinophilia
adult worms
tx - mebendazole or pyrantel pamoate
215
```
tapeworm
taenia saginata (beef)
taenia solium (pork)
diphyllobothrium latum (fish)
```
eating raw or undercooked meat
usually asymptomatic, abd pain, weight loss
fish tapeworm: vit b12 def
tx - praziquantel vit b12
216
Schistosomiasis (trematodes)
schistosoma haematobium
schistosoma japonicum
penetrating human skin ---> migrate to lungs -> portal vein --> venules of mesentery, bladder or ureters
S mansoni and S japonicum: fever, diarrhea, -> liver fibrosis, portal HTN
tx - praziuantel
