Flashcards in Infectious Disease Deck (59):
What are the most common causes of PNX in kids
C. and S. pneumoniae
Will tactile frem be increased or decreased in consolidation and Pleural effusion?
Consolidation = increased
pleural effusion = decreased
What are the specific tests for:
legionella: urine legionella Ag
chlamydia pneumoniae: serologic testing
mycoplasma: clinical dx or serum cold agglutinins
s. pneumo: urine pneumo Ag
In addition to S. pneumo, what other bugs cause PNX in COPD pts?
What bugs cause PNX in neonates?
What are the side effects of:
rifampin = orange fluids
ethambutol = optic neuritis
INH = peripheral neuropathy and hepatitis (always give B6 with INH)
TB treatment for active and latent dz?
active = RIPE x2months and IR x4 months
latent = INH x9 months OR INH x 6months OR rifampin x 4 months
Which strep do you have to be concerned about with acute pharyngitis? Dx test?
G.A.S. - dx w/ rapid GAS Ag test
early Abx therapy (PEN x 10 day) will prevent RHEUMATIC FEVER but can't stop glomerulonephritis
What is Lemierre's syndrome? what dz does it occur with?
The rare thrombophlebitis of the jugular vein
occurs due to Fusobacterium, an oral anaerobe
What bug are you concerned about with chronic sinusitis in a DM or hematologic malignancy pt?
Mucormycosis or rhizorpus
What is the tx for coccidioidomycosis infection?
PO fluconazole or itraconazole for mild or stable
IV Amp B for bad/disseminated cases
What accounts for why people can be infected with influenza (orthomyxovirus) multiple times?
Antigenic drift (slight point mutation changes)
Antigenic shifts describe a major change in the subtype and lead to PANDEMICS
Flu vaccine is recommended for...
everyone >6mo of age. kids 6mo to 9years need 2 doses of vaccine if it is their first time!
people ages 2-49yo who are healthy can get the live attenuated nasal spray. nOT WHILE PREGZ OR AIDS
What bacteria is responsible for most post viral PNX (occuring a week after being tx for influenza, particularly in old people.)
What are the most common bugs that cause meningitis in newborns 0-6mo?
E.Coli & GNRs
What are the 4 bugs that cause meningitis in old people >60yo?
Tx = Amp, vanc, and cef (tx this way for alcoholics, chronically ill too.)
What medication should you give to people in close contact to a pt with meningococcal men?
If they can't do rifampin, do cipro or cef.
What stain do you do to detect trypanosomes?
HSv, CMV, EBV?
PCR for all those other viruses
Brain abscess in a young male caused by paranasal sinusitis (direct spread) - what organism?
What is the tx for a pregnant woman w/ aids who is not on retroviral therapy at time of delivery?
Infant should get AZT for 6 weeks after birth
How low does the CD4 count get before you start antiretrovirals on an asymptomatic aids pt?
What is the only live vaccine you can give to AIDS pts?
DONT GIVE THEM OR THEIR CONTACTS LIVE POLIO VACCINE
When do you pre-treat HIV pts for P.J. pneumonia? With what?
MAC? With what?
Toxo? With what?
P.J. - tx when CD4 200 for 3mo
MAC - tx when CD4 100 for 6mo
Toxo - tx when CD4
What dz are you thinking if the pt was exposed to pigeon poop? Dx? Tx?
Cryptococcal meningitis. WONT HAVE MENINGEAL SIGNS!
Will have HA, fever, malaise and INCREASED ICP SIGNS
INDIA INK WILL BE + w/ + Crypto Ag stain of CSF
Tx: IV AMP B + flucytosine x 2 weeks, then do fluconAZOLE x 8 weeks
HIV pt who presents with nonproductive cough and dyspnea. CD4 count is VERY low. what disease? Dx?
Dx: Silver stain and immunofluorescence show FOLDED CYSTS CONTAINING COMMA SHAPED SPORES
CXR will show b/l interstitial infiltrates with a ground glass appearance
Tx: high dose TMP-SMX for 21 days...if they are hypoxemic, use a prednisone taper as well.
AIDS pt presents with "pizza pie" retinopathy, floaters, and visual field changes. very low CD4 count. What bug?
AIDS pt presents with nonspecific GI symptoms, bloody diarrhea. what bug?
CMV, it is called AIDS cholangiopathy
1* vs 2* MAC infection
1* = pulmonary disseminated infection that occurs in healthy (HIV) nonsmokers
2* = same thing but in not healthy COPD pts
Dx takes 2 WEEKs for blood cx to come back +. LDH and alk phos will be elevated. BX OF BONE MARROW OR LIVER will show foamy macs with acid fast bacilli
Tx vs prophylaxis of toxo?
Prophylaxis = TMPSMx or Pyrimethamine+dapsone given to pts with
What will the gram stain look like for chlamidia?
Nothing (PMNs but no bacteria) b/c the bugs are inside the cells!
Chlamidia tx in pregnant pts?
Azithro or Amox. Everyone else can get Doxy 7d.
Also, treat all sexual partners. For Gonn too probably
Cant pee, cant see, cant climb a tree
Reiters syndrome (can be caused by bad chlamydia infection.)
1*, 2*, 3* syphilis
1* - days 10-90 ; painless chancre on penis
2* - weeks 4-8 ; F/HA/LAD w/ rash on SOLES AND PALMS and highly infectious condylomata lata. can progress into early latent (no symptoms but +serology, up to first year) and late latent phase (no symptoms, + or - serology, after first year.) and 1/3 of cases will go to 3*
3* - 1-20 yrs ; destructive granulomatous gummas, tabes dorsalis, robertsons pupil, aortic root aneurysms
Tx for 1/2* syphilis
IM Pen Benz x1 day, doxy 14d for allergies (but if they are pregnant with allergies, you gotta sensitize to the pen)
What is the confirmatory test for syphilis?
FTA-Abs, TP-PA Abs
Flu like illness when syphilis is treated?
acute illness called Jarisch-Herxheimer reaction
Genital lesion - painless papule that becomes a beefy red ulcer w/ rolled edge of granulation tissue w/ white boarder. Dz? Dx? Tx?
Klebsiella Granulomatosis (granuloma inguinale)
Dx: bx shows donovan bodies
Tx: doxy or azithro
Genital lesion - painful papule or pustule/changroid that has irregular, deep, well demarcated necrotic apperance. May have inguinal LAD. Dz? Tz?
Tx: Azithro or ceftriaxone
Big thing you gotta rule out in bed wetting kids?
What is the cause of gram + septic shock?
gram - septic shock?
Gram + septic shock = fluid loss caused by EXOtoxins (SA and strep)
Gram - septic shock = vasodilation caused by ENDOtoxins lipopolysachs (Ecoli, kleb, proteus, pseudomonas.)
Is septic shock warm or cold?
warm skin and extremities.
CARDIOGENIC SHOCK IS COLD
What mosquito transmits malaria? What organisms? Dx?
organisms - plasmodium (falciparum, vivax, ovale, malariae)
falciparum is the deadliest, but the other ones can cause symptoms MONTHS TO YEARS after initial infection
Dx = Giemsa and Wright stained blood films
What does the anemia look like on labs for malaria?
Normo Normo anemia with reticulocytosis
Patient with mono symptoms develops a pruritic rash after treatment...
It was misdiagnosed as strep pharyngitis and treated with ampicillin. This will cause a rash in mono pts everytime that could be mistaken for an allergy against amp.
What causes the lymphocytosis in EBV?
B cells, but the atypical cells are the T cells!
What one physical exam step do you skip on a neutropenic pt?
Rectal examination - bleeding risk
What symptoms characterize 3* (late disease) lyme disease?
arthritis and subacute encephalitis (memory loss and mood change)
This occurs after the erythema migrans rash, the bells palsy, and the meningitis/myocarditis risk
Where does rocky mountain spotted fever rash start? what bug?
starts on the wrists and ankles and moves centrally.
Due to rickettsia rickettsii
What do you treat DM pts with eye infection concerning for mucor/rhizopus?
Amp B and surgical debridement
What is the most common cause of otitis externa (swimmers ear)
Person with recent gonorrhea infection gets an eye infection?
This is an emergency, person could go blind. Tx w/ IM cef, inpatient if needed
Eye infection w/ copius watery discharge, severe occular irritation, preauricular LAD. Dx?
Adenovirus conjunctivitis. Occurs in epidemics. Self limited
What is the most common bug in prosthetic valve endocarditis?
coag (-) strep
Difference between otitis media and otitis externa?
Pain when pulling on the tragus/pinna with otitis externa
What is the tx of choice for most infective endocarditis?
Cutaneous pruritic papule in a farmer/wool handler/mailman that turns into a black eschar with regional LAD. bug? Dx? Tx?
ELISA or CXR if inhaled (will have widened mediastinum)
Tx: cipro or doxy + 2 more Abx for 2wks
What is the most common form of osteomylitis in DM pts? Foot puncture?
What can a chonic draining sinus tract lead to?
Polymicrobial. (Gram + and anaerobic Abx will kill them)
SqCC (marjolin's ulcer)
What can you not do on metronidazole?
Drink alcohol (this can cause a disulferam rxn - hypotension, flushing, vomiting!)