Infectious disease Flashcards Preview

Step 2 > Infectious disease > Flashcards

Flashcards in Infectious disease Deck (44)
Loading flashcards...
1

Criteria for in patient, IV tx for pneumona

>65, comorbidities (ETOH, COPD, DM, malnutr), immunospr, malignancy, unstable vitals, AMS, multilobular

2

Empiric coverage: outpatient CAP

macrolide (eg azithromycin) or doxycycline

3

Empiric coverage: CAP requiring hosp

flouroquinolone or antipneumococcal b-lactam (eg piperacillin, ceftazidime) + macrolide (eg azithromycin)

4

Empiric coverage: CAP requiring ICU

antipneumococcal b-lactam (eg piperacillin, ceftazidime) + azithromycin or flouroquinolone

5

Empiric coverage: pneunomonia, critically ill, not responding to abx

vancomycin or linezolid, broad gram neg coverage

6

Empiric coverage: HAP

Extended-spectrum cephalosporin or carbapenem with antispeudomonal activity
Add aminoglycoside or flouroquinolone while sensitivity pending

7

Tb findings for normal host, immunocompr

Normal host: cavitary infiltrate upper lobe
Immunocompr, primary tb: lower lobe infiltrates, can be without cavitation
Miliary tb: multiple fine nodular densities

8

Tx: active and latent Tb

Active: 4x therapy (INH, pyriazinamide, rifampin, ethambutol) x2mo, INH+ rifampin x4mo
Latent: INHx9mo or rifampinx4mo

9

Common side effects:
-Rifampin
-Ethambutol
-INH

-Rifampin: turns fluids orange, P450 inducer
-Ethambutol: optic neuritis
-INH: peripheral neuropathy, hepatitis

10

Therapy for GAS

penicillin x10d
cephalosoprin, amoxicillin, azithromycin= alternatives

11

Lemierre's syndrome: defn, causative organsm

Thrombophlebitis of jugular vein after pharyngitis
fusobacterium (oral anaerobe)

12

odynophagia, trismus, muffled voice, asymmetric uvula: dx and tx

peritonsallar abscess, US or CT + Cx
Abx + surgical drainage

13

HIV+, filipin, Af Am, pregnant from SW US who present with respiratory infxn: dx and tx

Coccidiomycoisis
Tx: PO fluconazole or itraconozaole
IV amphotericin B for severe
progressive symptomatic disease: surgery+ long term azole (8-12mo)

14

Meningococcal meningitis: Ppx and tx

Ppx: rifampin
Tx: ceftriaxone

15

Important adjunctive treatment for meningitis

Dexamethasone: (esp S. pneumo, H flu), give 15-20min before abx

16

Cerebral edema: dx tests and tx

loss oculocephalic reflex
CT/MRI
tx: IV mannitol

17

subdural empyema: presentation and tx

intractable seizures
Tx: surgical evacuation

18

CSF findings: bacterial vs viral menigitis

Bacterial: incr WBC (>1000 PMNs), decr glc, incr prot (>45) and opening pressures (>20)
Viral: Incr WBCs (mono/lymph), prot and opening pressure may be incr or normal

19

CSF finding: MS

incr gamma globulin

20

RBCs in CSF without a hx of trauma

HSV encephalitis

21

India ink stain (CSF)

cryptococcus

22

Giemsa stain (CSF)

trypnaosomes

23

Empiric treatment: meningitis

ampicillin + cefotaxime or gentamicin

24

Empiric treatment: Meningitis >1mo-adult

vancomycin + cetriaxone or cefotaxime

25

Empiric treatment: meningitis >60/ETOH

ampicillin + vancomycin + cefotaxime or cetriaxone

26

cranial nerve defects assoc with incr ICP, nature of headache

CN III, VI

27

headache, fever, local neuro deficit: dx and tx

typical of brain abscess (consider brain met if no fever)
Surgical drainage if >2cm
3rd gen cephalosporin (ceftazidime, ceftriaxone) + metronidazole +/- vancomycin (6-8wks)
Dexa/ IV mannitol

28

When start HAART, what use?

symptomatic pt, CD4

29

pseudohyphae + budding yeast, germ tupes at 37 deg: dx and tx

candida
PO azole

30

45 deg branching septate hyphae with rare fruiting bodies: dx and tx

aspergillus

31

5-10mm wide capsular halo with narrow-based unequal budding: dx and tx

cryptococcus
IV amphotericin B + flucytosine for 2 wks, fluconazoel x 8wks (for meningitis)

32

Irregular broad nonseptate hyphae with wide-angle branching: dx and tx

mucor

33

fever, weight loss, HSM, LAD, cough, palatal ulcers, ohio or spelunking: dx and tx

histoplasmosis
urine and serum polysaccharide antigen
Mild: itraconazle (cavitary lesion- >1yr)
severe/ dissem: amphtericin B x 14 d then itraconazole

34

"pizza pie" retinopathy with retinal detachment
floaters and visual field changes

CMV retinitis
tx: ganciclovir or foscarnet

35

Polyradiculopathy, transverse myelitis, subacute encephailtis in immunocompr

CNS involv CMV

36

fever, weakness, weight loss in immunocomp, anemia, incr alk phos and LDH: dx, tx (ppx and tx)

MAC
Bx: foamy macrophages with acid-fast bacilli
Tx: clarithromycin or ehtambutol +/- refabutin
ppx: azithromycin (CD4

37

Isodense or hypodense ring-enhancing mass lesions with predilection for basal ganglia: dx and tx

toxo
tx: pyrimethamine + sulfadiazine or leucovorin x 4-8wks
TMP -SMX ppx (CD4

38

anal pruritis with discharge, rectal strictures, rectovaginal fistula, elephantitis: dx

anogenital syndrome, tertiary lynphogranuloma venerium (chlamydia)
tx: doxy or azithromycin once; prolonged tx 21d

39

monoarticular septic arthrit, rash (hemorrhagic, panful pustules with erythematous bases), tenosynovitis: dx and tx

gonorrhea (disseminated
IV cetriaxone for at least 24h

40

hypotension with warm skin and extremities: dx and tx

septic shock
IVF, empiric abx, vasopressors

41

periodic fevers/ chills (>105.8), dipahoresis, splenomegally: dx, workup, tx (+ ppx)

Malaria (P falciparum- highest morbidity, vivax, ovale, malariae)
Giemsa or Wright-stained thick and thin blood films
cholroquine= standard tx
primaquien for p vivax or p ovale (to eradicate liver hynpozoites)
Severe infxn IV quinidine
Mefloquine for chemoprophylaxis

42

headache, fever, malaise, macular rash that starts and wrists/ankles and spreads ceantrally: dx and tx

rocky mountain spotted fever (reikettsia rickettsii) via american dog tick
tx: doxy or chloramphenical (for pregnant)

43

conjunctivitis, gram stain shows gram neg intracell diplococci: dx and tx

N. gnorrhea, IM ceftriaxione, PO cipro or oxfloxacin emergently

44

Recurrent epithelial keratitis in children, + giemsa stain: dx and tx

C. tracomatis
Axithromycin, tetracycline or erythromiycin for 3-4 wks