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Flashcards in Infectious Disease Deck (313)
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1

MCC bacterial endocarditis

staph aureus

2

Native valve endocarditis

Staph aureus, strep bovix, strep gp D (enterococci) -> Vanco/gentamycin empiric

3

Prosthetic valve

staph epi, streptococci, G neg fungi -> vanco, rifampin (clears sticky bugs - staph epi), gentamycin

4

IVDU

staph aur, enteroccus, g neg strep viridans -> vanco + gentamycin

5

Indications for endocarditis surgery

Severe CHF - bacteremia x 6 days (if repeat bcx 48 hrs +, cont abx, repeat ctx, recurrent emboli, valve abscess, large fungal vegetation

6

Rt sided endocarditis with septic emboli - abx?

Daptomycin

7

Pt with sympt endocarditis - bctx done, vanco/gent started - 72hrs later bctx + strept sens to PCN - abx changed to PCN - gnet d/c'd - reepat bctx still + 24hrs later wtd?

continue abx, repeat bctx in 48hrs

8

IVDA rec with fever, cough hempotysis, pleuritis CP - II/VI SEM - 2-3 nodules on CXR - dx?

Rt sided endocarditis -> vanc/gent

9

Pt fever, +BCtx for clostr sept/ Strep bovis - wtd

Colonoscopy r/o malignancy

10

IVDA suspected for endocarditis vanc/gent started - ctx +PCN enterocci - vanc stopped - pcn started but then with prurtis swelling lip swelling - wtd?

D/C PCN start vanc

11

Vanc develops itching/redness

redman's - slow IV infusion +- benadryl

12

Pt s/p TURP 2 wks later with fever growing enterococci

older men, AV>MV, more CHF less embolic events, more conduction defects - don't use ceftriaxone (doesn't kill)

13

Valve replacement

NOT in pt febrile on abx - mild AR EF 60% - BUN cr 25/2 -> immune complex phenomenon - see splinter hemorrhage, janeway lesion, roth spots

14

Pt treated for endocardtisi defervesces and WBC dec bu twith 1st deg AVB - concerned?

yes - r/o valvular abscess - TEE

15

Pt on imipenum/cilastatin for nosocomial infxn h/o seizure d/o - has dz - related to imipenum?

Yes - inc'd incidence of seizures at higher doses

16

Endocarditis ppx only for high risk procedures in high risk conditions...

High risk condition - ALL prosthetic valve, prev h/o endocarditis, congential heart dz, unrepaired CHD, repaired CHD within 6 months, post tx heart WITH valvular dz, repaired CHD with prostesis or patch (forever)
High Risk procedure - likely to cause bleeding->endocarditis - dental extraction, periodontal procedures, root canal, implants
NOT HIGH RISK - GI/GU (only if risk of mucosal damage
Low risk conidtions - ASD secundum, 6 months after repair of ASD/VSD/PDA, prev CABG/HOCM, PPM, MVP with murmur MS/AS, fxn murmur
Low risk procedures - cavity filling, endotrach intub, bronch all GI/GU, vaginal hyterectomy, D/C C section, IUD, cath, circumcision

17

Endocarditis ppx

Amox 2g po 1 hr prior, if no PO then amp IV, PCN all - azithro, post procedure - > NOTHING

18

Pt witih PDA going for cystoscopy

NO ppx

19

Pt with bacteremia s aur due to IV line - vanc started wtc

TTE - neg tx x 2 weeks, + tx 4-6 weeks

20

Pt with susp diverticulitis pw f/c/abd pain - 3 days later temp 101, catheter site clean wbc 17K - wtd

vanc/imipenum

21

obesity with vanc

1.5g IV q12h

22

Surgical site infxn ppx

IV abx 1 hr prior to surgery/24 hrs after

23

35yo IVDA fever/chills wit hmurmur, vegetation on TV bctx MRSA - tx?

Daptomycin

24

Empiric tx meningitis

Head trauma/NSx - staph aur MRSA, S pneumo, G neg bacilli - vanc + ceftazidme
60yo Listeria, S pneumo, neisseria -> Ampicicillin (listeria), CFTtx (S pneumo), Vanco (MRSA)
15yo - S.pneuo, neisseria, h flu -> Ceftriaxone
2 month - strep agalactiae, E. Coli, Listeria - Ceftx + ampilcillin (listeria)

25

Normal CSF

<5cells, lymph, Gluc 40-80, Protein 15-45

26

Bacteria CSF

10-100K cells, PMNs, dec gluc, inc protein, inc opening pressure

27

West nile CSF

10-1K cells, Lymph, dec gluc, inc protein, muscle wk, rash, dec DTR

28

TB CSF

10-1K, lymph, dec gluc, very inc protein,

29

Aseptic CSF

10-2K, lympoh normal gluc, inc to normal protein, enterovirus, OKT3, NSAIDS, bactrim

30

Early bacterial CSF

10-1K, lymphs > PMN, dec gluc, inc protein, CSDF to ser glu <0.4