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Infectious Disease Flashcards

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1
Q

Common causes of PNA in Neonates

A

GBS
E. coli
Listeria

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2
Q

Common causes of PNA in Children (6w-18y)

A 
Viruses
S. pneumoniae
Mycoplasma
Chlamydia pneumoniae
S. aureus
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3
Q

Common causes of PNA in Adults (18-40)

A

Mycoplasma
S. pneumoniae
Viruses
C. pneumoniae

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4
Q

Common causes of PNA in Adults (40-65)

A 
S. pneumoniae
H. flu
Mycoplasma
Viruses
Anaerobes
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5
Q

Common causes of PNA in Elderly (65+)

A 
S. pneumoniae
H. flu
Viruses
S. aureus
GNRs
Anaerobes
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6
Q

Causes of PNA: Atypical

A

Mycoplasma
Legionella
Chlamydophila (chlamydia)

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7
Q

Causes of PNA: Nosocomial

A

GNRs
Staph (MRSA)
Anaerobes
Pseudomonas (intubated pts)

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8
Q

Causes of PNA: Immunocompromised

A 
Staph
Gram + rods
Fungi
virus
PCP
Mycobacteria
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9
Q

Causes of PNA: Aspiration

A

Anaerobes

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10
Q

Causes of PNA: Alcoholics/IV drugs

A

S. pneumo
Klebsiella
Staph

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11
Q

Causes of PNA: Cystic Fibrosis

A

Staph (under 20)
Pseudomonas (over 20)
Burkholderia
mycobacteria

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12
Q

Causes of PNA: COPD

A

H flu
Moraxella catarrhalis
S pneumo

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13
Q

Causes of PNA: Post-viral

A

Staph
S pneumo
H flu

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14
Q

Causes of PNA: Neonates

A

GBS
E. coli
Listeria

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15
Q

Causes of PNA: Recurrent

A

Obstruction, bronchogenic carcinoma, lymphoma, Wegener’s, immunodef., unusual organisms (nocardia, coxiella, aspergillus, pseudomonas)

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16
Q

Treatment of PNA: CAP

A

Macrolide (Azithromycin, Erythromycin) or Doxycycline

[S. pneumo, mycoplasma, chlamydia, h flu, viral]

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17
Q

Treatment of PNA: with comorbid disease

COPD, HF, CKD, DM, Liver
>65, or recent ABx (in 3 mo)

A

Fluoroquinolone (levofloxacin, moxyflocacin)
or Betalactam + macrolide (Ceft/Azith)

[S pneumo, H flu, E. coli, enterobacter, klebs, s aureus, legionella, virus]

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18
Q

Treatment of PNA: CAP req hospitalization

CURB-65

A

Fluoroquinolone (levo)
or antipneumococcal betalactam + macrolide (Ceft/Azith)

[S pneumo, h flu, anaerobes, E. coli, klebs, legionella, chlamydia]

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19
Q

Treatment of PNA: CAP req ICU

A

Antipneumococcal beta-lactam

+ either azythromycin or fluoroquinolone

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20
Q

Treatment of PNA: HCAP

A

cefepime or imepenem/meropenem
+ gentamycin or levofloxacin

Extended spec Cephalosporin
or carbapeneme with antipseudomonal
-Add aminoglycoside or fluoroquinolone for resistant organisms

[GNRs (pseudomonas, acinetobacter), s aureus, legionella, mixed]

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21
Q

Treatment of PNA: critically ill

A

Add vancomycin or linezolid, broaden gram neg coverage

[MRSA]

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22
Q

Rx for TB: agents

A

RIPE for treatment

Rifampin {orange body fluids}
INH {peripheral neuropathy, hepatitis}
Pyrazinamide
Ethambutol {optic neuritits}

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23
Q

Rx for TB: duration

A

Active: 4 drug x2 mo; then INH + rifampin x4 mo
–Give Vitamin B6, pyridoxine, to prevent INH peripheral neuropathy

Latent: INH x 9 mo (or 6 mo, or rifampin x4 mo)

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24
Q

Causes of acute sinusitis

A

++viruses
strep pneumoniae
H flu
m catarrhalis

bacterial = rare, has purulent nasal discharge, symptoms > 10 days

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25
Complications of sinusitis
``` Meningitis Frontal bone osteomyelitis Cavernous sinus thrombosis abscess Orbital cellulitis (post-septal) ```
26
Rx for sinusitis
Acute: amox/clav x10 days (or azith, bactrim, 2nd gen ceph) Chronic: same Abx for LONGER: 3-6 wks
27
Pt from Nevada, Arizona, New Mexico, California, Texas (mexico) with respiratory complaints? also Rx?
Coccidioidomycosis Rx: PO fluconazole or itraconazole IV amphotericin B if severe
28
HIV+, pregnant, filipino, black from SW state?
Increased risk for disseminated Coccidioidomycosis
29
fever, myalgias, chills, cough, coryza, but rapid flu negative?
Still think flu, rapid flu test has low sensitivity PCR assays, DFA and viral culture more definitive
30
Rx for influenza
symptomatic oseltamivir or zanamivir IF WITHIN 2 DAYS OF ONSET can reduce duration of illness by 1-3 days
31
Causes of Meningitis by Age: Newborn
GBS E. coli/ GNRs Listeria
32
Causes of Meningitis by Age: Children (6mo-6y)
S. pneumo N. meningitidis H flu type b Enterovirus
33
Causes of Meningitis by Age: 6y-60y
N. meningitidis (#1 in teens) S pneumoniae Enteroviruses HSV
34
Causes of Meningitis by Age: >60
S pneumoniae GNRs Listeria N meningitidis
35
Empiric Rx for Meningitis by Age: Neonate
Ampicillin + cefotaxime or gentamicin [GBS, E coli, Listeria]
36
Empiric Rx for Meningitis by Age: 1mo-3mo
Vancomycin IV + Ceftriaxone or Cefotaxime [pneumococci, meningococci, h flu]
37
Empiric Rx for Meningitis by Age: 3mo - adult
Vancomycin IV + Ceftriaxone or Cefotaxime [pneumococci, meningococci]
38
Empiric Rx for Meningitis by Age: >60, ETOH, Chronic Illness
Ampicillin + vancomycin + cefotaxime or ceftriaxone [pneumococci, gram neg bacilli, listeria, meningococci]
39
Rx for contacts of meningococcal meningitis
RIFAMPIN, CIPROFLOXACIN or ceftriaxone
40
Dexamethasone in meningitis?
Reduce neurologic complications of S PNEUMO meningitis if given 15-20 MIN BEFORE ABX
41
Complications of meningitis
``` SENSORINEURAL HEARING LOSS mental impairment seizures increased ICP empyema abscess focal neuro deficits, coma, death hyponatremia ```
42
RBC in CSF, no history of trauma?
highly suggestive of HSV encephalitis
43
CNS Infection key words: Photophobia, nuchal rigidity
meningitis
44
CNS infection key words: Focal neurologic deficits
brain abscess
45
CNS infection key words: Confusion, mental status changes
Encephalitis
46
HSV Encephalitis: Dx & Rx?
PCR highly sensative and specific CT or MRI shows TEMPORAL LOBE SIGNAL Rx with IV Acyclovir asap
47
CMV encephalitis Rx?
IV Ganciclovir +/- foscarnet
48
Brain abscess imaging?
Ring-enhancing lesion If hematogenous spread, multiple abscess at Grey-white junciton in middle cerebral distribution
49
Fever, confusion, dull constant headache, no relief with nsaids, papilledema, CN III and CN VI palsy?
indicative of brain abscess
50
Fever, headache, focal neurological deficit?
Triad for Brain Abscess present in 50% of cases
51
Rx for brain abscess?
IV Abx and surgical drainage (no surgery if less than 2 cm)
52
CD4 ~ 500 also ppx?
``` Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi Sarcoma TB and bact. infections ``` Bactrim (50?)
53
CD4 less than 200 also ppx?
``` PCP Toxo Cryptococcosis Coccidioidomycosis Cryptosporidiosis ``` Bactrim double strength (100?)
54
CD4 less than 50 also ppx?
Disseminated MAC Histoplasmosis CMV retinitis CNS lymphoma Azithromycin
55
Side effects: Protease Inhibitors
hyperglycemia hyperlipidemia lipodystrophy
56
Side effects: Thiazides
``` Hyperglycemia Hypertriglyceridemia Hypercalcemia Hyponatremia Hypokalemia Hypomagnesemia ```
57
Side effects: Nucleoside RTIs
Bone marrow suppression neuropathy lactic acidosis?
58
Side effects: Indinavir
crystal-induced nephropathy | nephrolithiasis
59
Side effects: Didanosine
pancreatitis
60
Side effects: Abacavir
hypersensitivity
61
Side effects: Nevirapine
liver failure
62
Side effects: Efavirenz
vivid dreams, hallucinations
63
Pizza pie retinopathy, floaters and visual field changes, association with retinal detachment
CMV retinitis CD4 less than 50
64
Bloody diarrhea, abdominal pain, CD4 less than 50
CMV colitis
65
Systems CMV manifests in AIDS?
Retinitis (retinal detachment) GI & hepatobiliary (bloody diarrhea) pneumonitiis (coufh, sparse sputum, high mortality) CNS (polyradiculopathy, transverse myelitis, encephalitis)
66
Rx for CMV infection?
Ganciclovir or valganciclovir +/- foscarnet
67
Fever, weakness elevated Alk Phos and LDH HIV not on HAART biopsy shows foamy macrophages with acid-fast bacilli
MAC, disseminated if CD4 less than 50
68
multiple hypodense ring-enhancing mass lesions on CT/MRI
Toxoplasmosis encephalitis Rx is high dose PO pyrimethamine + sulfadiazine and leucovorin (folic acid analog prevents heme toxicity) for 4-8 weeks Bactrim as prophylaxis if CD4 less than 100
69
Ring-enhancing lesions in AIDs
Toxoplasmosis CNS lymphoma (abscess?)
70
Chlamydia Rx in pregnancy?
Azithromycin or Amoxicillin
71
Chlamydia Rx
Doxycycline x7days or azithromycin
72
Reiter Syndrome?
Complication of Chlamydia | urethritis, conjunctivitis, arthritis
73
Fitz-Hugh-Curtis Syndrome?
complication of chlamydia perihepatic inflammation and fibrosis
74
Hemorrhagic, painful pustules on erythematous base Monoarticular septic arthritis Tenosynovitis also Rx?
Disseminated gonorrhea Ceftriaxone IM and Azithromycin PO
75
Rx syphilis
Benzathine PCN IM | or Tetracycline/doxycycline x14 days in PCN allergy
76
Rx syphilis in pregnancy
Benzathine PCN If allergic, desensitize and rx with PCN
77
Headache, fever, chills, myalgias, just started PCN for rash on palms and soles
Jarisch-Herxheimer reaction, from release of endotoxins from killed syphilis organisms (treponema pallidum)
78
Common UTI bugs
SEEKS PP ``` Serratia E COLI Enterobacter Klebsiella Staph saprophyticus Pseudomonas Proteus mirabilis ```
79
Beefy red genital ulcer with rolled edge of granulation tissue Painless Granulomatous ulcers also Rx?
Klebsiella Granulomatis aka Granuloma inguinale Rx Doxy/Azith
80
Painful papule or pustule on genitals irregular, deep, necrotic 1-2 cm Inguinal lymphadenopathy also Rx?
Haemophilus ducreyi ("do cry") Rx Azith or Ceftri
81
Rx uncomplicated UTI
PO bactrim, fluoroquin x3 days or nitrofurantoin x5
82
Rx complicated UTI | obstruction, men, renal txplant, catheters, instruments
PO bactrim, or fluoro or nitro x7-14 days
83
Rx UTI in pregnancy
AMOXICILLIN 3-7 days or nitrofurantoin or oral cephalsporin treat asympto and sympto, to prevent pyelonephritis
84
Rx pyelonephritis
Fluoroquinolones if severe, admit, 3rd/4th gen cephs, carbapenems, beta/lactamase inhibs
85
Rx pyelonephritis in pregnancy
Admit, 3rd gen cephalosporin
86
SIRS criteria
Temp 38 RR >20 HR >90 WBCs 12000
87
Deadliest form of malaria?
Plasmodium falciparum (falchion) others P vivax, P ovale, P malariae
88
Dx of malaria?
Giemsa- or Wright-stained thick and thin blood films or rapid antigen, fluorescent antibody, or PCR if available
89
Rx for malaria?
Chloroquine PO + Primaquine for P vivax & P ovale or Unknown to eradicate hypnozoites in liver If severe, IV Quinidine
90
Malaria prophylaxis?
Atovaquone-proguanil and mefloquine first line for chloroquine-resistant malaria
91
Young adult, fever, fatigue, sore throat, posterior cervical lymph nodes, complains of facial droop, blurred vision, and numbness/weakness spreading up his legs
CNS infection, complication of EBV Infectious Mononucleosis can be meningitis, encephalitis, CN palsies (VII), optic neuritis, transverse myelitis, or Guillain-Barre syndrome
92
Young adult male, fever, fatigue, sore throat, posterior cervical lymph nodes, develops RUQ pain, jaundice, confusion, and abnormal LFTs
Fulminant hepatic necrosis, complicatino of EBV Infecitous mononucleosis
93
Most common cause of Fever of Unknown Origin
Infection and cancer ~ 60% Autoimmune disease ~15% in elderly, rheumatic dz is 1/3 of cases
94
Rx for Fever of Unknown Origin with negative work-up
Stop unnecessary medications No empiric ABx indicated Good prognosis, most resolve in months to years
95
Rx for Neutropenic Fever
Empiric Antipseudomonal agent (cefepime, piperacilin-tazobactam) If persists >72 hours, start antifungal Rx
96
Headache, fever, chills, myalgias, confusion travel to louisiana, camping Leukopenia, thrombocytopenia Elevated LFTs
Ehrlichiosis from lone star tick Rx Doxycycline Rash uncommon
97
Headache, fever, malaise, macular rash on wrists and ankles that spreads to body as petechial/purpuric rash
Rocky Mountain Spotted Fever rickettsia reckettsii small vessel vasculitis Rx Doxycycline or chloamphenicol for pregnancy
98
Injected conjunctiva, eye pain, discharge, gram stain shows gram - intracellular diplococci
EMERGENCY! Neisseria gonorrhoeae infection Corneal involvement can perforate and cause blindness IM or IV Ceftriaxone, admit if complicated
99
Copious watery eye discharge, severe ocular irritation, preauricular lymphadenopathy
Adenovirus contagious, but self-limited
100
Neonate with mucopurulent conjunctivitis
Chlamydia trachomatis Rx Azithromycin, tetracycline, or erythromycin x3-4 weeks
101
PE feature of Infective Endocarditis
FROM JANE ``` Fever Roth Spots (retinal hemorrhage) Osler nodes (tender nodules on finger/toe) Murmur (mitral valve) Janeway lesions (periph. hemorrhage) Anemia Nail hemorrhage (splinter) Emboli (focal neuro deficit?) ```
102
Causes of acute endocarditis
S aureus (IV drug, prosthetic valve) S pneumoniae N gonorrhoeae
103
Causes of subacute endocarditis
``` Viridans strep (native valve, dental procedures) Enterococcus (UTIs) S epidermidis (prosthetic valve) S bovis (GI insult, malignancy) Fungi ```
104
Causes of marantic endocarditis
Cancer Metasteses seed valves, emboli cause cerebral infarct poor prognosis
105
Causes of culture negative endocarditis
``` HACEK Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella ``` also coxiella, brucella, bartonella
106
Endocarditis and SLE
Libman-sacks endocarditis | antibodies to the valve
107
Rx endocarditis
IV vancomycin + gentamicin, then tailor
108
hunter or rancher presents with pruritic papule, becomes ulcer, develops black eschar a week later also Rx?
Cutaneous anthrax (bacillus anthracis, gram +) Rx Ciprofloxacin or doxycycline plus 1-2 additional Abx for 14 days
109
Sheep rancher with fever, hypoxia, hypotension, cough, SOB, CXR shows widened mediastinum and pleural effusions also Rx?
Pulmonary anthrax causing hemorrhagic mediastinitis Cipro/doxy plus 1-2 additional ABx for 14 days
110
Osteomyelitis in otherwise healthy?
Staph aureus
111
Osteomyelitis in IV drug user
S aureus or pseudomonas
112
Osteomyelitis in Sickle Cell disease
Salmonella (no spleen, capsulated organism)
113
Osteomyelitis in Hip replacement
S epidermitis
114
Osteomyelitis in foot puncture wound
pseudomonas
115
Chronic osteomyelitis
S aureus, psudomonas, enterobacteriaceae
116
Osteomyelitis in diabetic
polymicrobial, pseudomonas, s aureus, strep, anaerobes
117
Risk factors for osteomyelitis
``` peripheral vascular disease diabetes penetrating injury chronic decubitus ulcer IV drugs (vertebral) ```
118
Rx for diabetic with osteomyelitis
target g+ and anaerobes vancomycin and clindamycin
119
Rx Toxoplasmosis encephalitis
pyrimethamine + sulfadiazine + leucovorin Rx is high dose PO pyrimethamine + sulfadiazine and leucovorin (folic acid analog prevents heme toxicity) for 4-8 weeks
120
Most common cause of PNA in CF child (under 20)
Staph aureus
121
Most common cause of PNA in CF adult (over 20)
Pseudomonas aeruginosa
122
22 yo male, fever, sore throat, malaise cervical and axillary lymphadenopathy Hepatosplenomegaly Jaundice What am I? Complication?
Infectious Mononucleosis Autoimmune hemolytic anemia (EBV ab's cross react with RBCs and Platelets)
123
Most common cause of sepsis in child with sickle cell?
Strep pneumo DESPITE VACCINATION (other serotypes) hence PCN ppx
124
Classic triad of congenital rubella
deafness, cataracts, cardiac defects (PDA, VSD)

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