Infectious disease Flashcards
(185 cards)
1
Q
How to reduce surgical site infection
A
Evaluate for staph aureus nasal carriage 2 weeks before surgery and decolonize if positive (most surgical site infections are due to s. aureus). If positive, patients need preoperative decolonization.
2
Q
Preoperative antibiotic prophylaxis for surgical site infection
A
- Cefazolin 1-2 hours before incision (unless MRSA nasal carriage, then vanc)
3
Q
Coccidoidomycosis clinical features
A
similar to TB + peripheral eosinophilia + California
4
Q
Coccidoidomycosis treatment
A
fluconazole
5
Q
Empiric CAP treatment in patient requiring ICU
A
Use agent active against legionella (macrolide or quinolone) instead of atypical coverage
6
Q
B-lactams
A
ampicillin-sulbactam
cefotaxime
ceftriaxone
ceftaroline
7
Q
pseudomonal RF’s
A
Health care interaction
Previous antibiotic use
8
Q
Workup of fever of unknown origin
A
(TB, bacteremia, HIV, abdominal infection) CBC, CMP 3 blood culture sets Urine culture ESR TB testing HIV CT abdomen
9
Q
Criteria for Fever uf unknown origin
A
Fever of 100.9 or greater for 3 or more weeks undiagnosed after 2 visits in the ambulatory setting
10
Q
Leptospirosis clinical features
A
Hawaii + uveitis + rash + sepsis + LAD + kidney injury + HSM
11
Q
What is acute retroviral syndrome?
A
Acute symptomatic illness when patients develop HIV
12
Q
Management of complicated fulminant (severe) C diff infection
A
Oral vanc + IV flagyl (reduced absorption)
13
Q
Severe c diff defined as
A
serum Cr >1.5 or WBC >15
14
Q
complicated fulminant c diff defined as
A
Complicated by ileus, hypotension, shock, or toxic megacolon
15
Q
Post lyme disease syndrome clinical features
A
Persistent fatigue + headache + myalgia + arthralgia following lyme disease treatment
16
Q
hallmark of babesiosis
A
hemolytic anemia
17
Q
presentation of late stage lyme disease
A
inflammatory arthritis involving larger joints
18
Q
presentation of mycobacterium fortuitum
A
Chronic, non healing ulcers and wounds that don’t respond to antibiotics
19
Q
most common cause of pulmonary disease from NTM
A
MAC (mycobacterium avium complex)
20
Q
Leprosy clinical features
A
chronic skin lesions + sensory loss in extremities
21
Q
PID features
A
lower abdominal pain + vaginal discharge
22
Q
Outpatient/ED treatment of PID
A
Single dose of IM CTX + oral doxycycline for 14 days
23
Q
Only indications for treating ASB
A
1) Pregnancy
2) medical clearance before an invasive urologic procedure
24
Q
Postexposure prophylaxis and testing for person who has needle stick from HIV positive patient (components)
A
- 3 drug regimen for 1 month
Tenofovir + emtricitabine + either dolutegravir or raltegravir - test immediately, 4-6 weeks later, and 3 months after exposure
25
management of acute, uncomplicated pyelo with transient bacteremia
Complete oral antibiotic course outpatient
26
patient groups susceptible to giardia
1) Selective IgA deficiency
| * **Preschool
27
Salmonella features
most common cause of foodborne illness + non bloody diarrhea + self-limited
28
Listeria clinical features
headache + fever + non bloody watery diarrhea + pain in muscles and joints
29
How to test for possible Zika exposure
If exposure more than 2 weeks previously, test for IgM antibodies
30
Most frequent manifestation of Zika in newborne
microcephaly
31
Management of pregnant woman with proven zika
Serial US q3-4 weeks
32
What is Ramsay Hunt syndrome + pathogen
Ear pain + vesicular rash in the external ear + ipsilateral peripheral facial palsy + deafness
(reactivation of herpes zoster in the geniculate ganglion)
33
Problem with live attenuated zoster vaccine
Has 64% efficacy that decreases to 36% after 6 years
34
Bell palsy clinical features
Isolated paralysis of the facial nerve + complete unilateral facial paralysis
35
Cause of bell Palsy
HSV 1
36
Features of Q fever pneumonia
- exposure to livestock/farm animals (farmers, veterinarians, and abattoir workers)
- mild pneumonia
37
Infection and clinical features associated with chlamydia psitacci infection
- Psittacosis
- PNA associated with abrupt onset of fever + HA + dry cough
- inhalation of dried bird droppings
38
Clinical features + reservoir of infection due to yersinia pestis
- Pneumonic plague
- rodent exposure
- sudden high fever + pleuritic chest pain + productive cough + hemoptysis + (patients are very very sick)
39
Antibiotics for an infected cat bite
Unasyn + vanc IF RF's for MRSA (pus forming) (infections are caused by both organisms from animals mouth flora and the host's skin flora)
40
Ehrlichiosis infection clinical features
Febrile illness + leukopenia + thrombocytopenia + elevated liver enzymes
41
Management of health care-associated ventriculitis (after neurosurgery)
Remove ventricular device
42
Treatment of disseminated histo
Liposomal amphotericin B
43
Signs of disseminated histo
Oral ulcerations + hepatosplenomegaly + pancytopenia
44
empyema diagnosis
thora with purulent or foul-smelling material OR a positive gram stain
45
organism causing most malaria
Plasmodium falciparum
46
typhoid fever clinical features
Fever + diarrhea + transient small blanching skin lesions (rose spots)
47
leptospirosis presentation
Fever + myalgias + HA + conjunctival suffusion (conjunctival injection without exudate)
48
When you should never use daptomycin
lung pathogens (binds to surfactant)
49
Initial management of new diagnosis of HIV
- Viral load
- *Genotypic* viral resistance testing
- Start HAART as soon as patient is ready
50
Most common causes of meningitis during different seasons
```
Enterovirus = May-November
Winter = HSV-2
```
51
CSF findings in viral meningitis
Normal glucose
Lymphocytic pleocytosis (High WBC's in CSF)
Mildly elevated protein level
52
Management of patient testing positive for hep B surface antigen + negative for hep B surface antibody
Patient has had HBV infection and would have no benefit from immunization with HBV vaccine
53
What is neuroborreliosis
sequela of lyme disease due to CNS involvement (nuchal rigidity, headache, facial nerve involvement)
54
Management of lyme disease with CNS features
LP before treatment
55
Treatment of neuroborreliosis
parenteral therapy -- CTX, cefotaxime or penicillin
56
Management of anthrax exposure
IF no known direct exposure, no need to test or quarantine (don't need to separate members of household)
57
Postexposure ppx for anthrax
ABX for 60 days (cipro, levo, or doxy)
58
Prep administration and components
Tenofovir + emtricitabine once daily
59
PREP monitoring
need to check kidney function
60
Indications for amputation with diabetic foot infections
- persistent sepsis
- not tolerating antibiotics
- progressive bone destruction despite therapy
- bone destruction compromising mechanical integrity of the foot
61
management of patient with positive treponemal serology and negative nontreponemal test (RPR)
no treatment (this is successfully treated syphilis)
62
nontreponemal test
RPR
63
Leading cause of swimming pool-related outbreaks of diarrheal illness
cryptosporidium
64
How to reduce central line associated infections
- assess daily for continued necessity
| - NO routine replacement of central lines
65
Treatment of cyclospora infection
Oral bactrim
66
Management of HIV meds in pregnant woman
Continue same regimen
67
Hep A vaccination protocol
Single injection 2-4 weeks before travel to an endemic region (but single dose at any time before travel provides adequate protection)
68
management of ESBL UTI
Carbapenems (even if culture suggests some sensitivity to zoey or other antibiotic, this is low sensitivity)
69
monitoring for daptomycin
Weekly creatinine + CK
| should discontinue statin
70
Cause of kaposi sarcoma
HHV type 8
71
Treatment for kaposi
ART
Local therapies (RT, intralesional chemo, cryotherapy, retinoids)
Chemo or INF
72
Treatment of MSSA osteoporosis associated with orthopedic hardware
IF hardware can't be removed --> Rifampin (synergistic) + anti staphylococcal agent (cefazolin)
73
When to treat animal bites
- immunosuppressed patients (cirrhotics, asplenia)
- wound with edema
- venous insufficiency
- crush injury
- wound involving joint or bone
- deep puncture wound
- face, genitalia, or hand involvement
74
Antibiotic used for multi-drug resistant intra-abdominal infection
Ceftolozane-tazobactam and colistine
75
Antibiotic used for UTI's caused by multidrug-resistant organisms
Fosfomycin
76
When to treat influenza with tamiflu
IF hospitalized or outpatient w/ severe or progressive illness --> as soon as possible regardless of illness duration
IF otherwise healthy --> only if started within 48 hours of symptom onset
77
Board answer to additional study needed for urosepsis
kidney ultrasound or CT with contrast if Cr okay
78
Test results in Acute HIV
* Negative antibody differentiation immunoassay (prior to antibody development)
- positive HIV-1 nucleic acid amplification test
79
What is urethritis?
Dysuria + purulent discharge,
80
Treatment of urethritis
Empiric ceftriaxone + azithromycin
81
Prophylaxis for transplant patients
Bactrim
Posaconazole
*Acyclovir while neutropenic
82
Why acyclovir is given for transplant patients during periods of neutropenia
Reduce reactivation of HSV
83
Preferred agent for antibacterial prophylaxis during neutropenia and why
Cipro (active against most gram-negative bacteria)
84
Treatment of TB meningitis
RIPE + dexamethasone (mortality benefit)
85
Most common causes of chronic meningitis
TB and cryptococcus
86
When to suspect TB meningitis
- endemic country (eg mexico) **lymphocytic meningitis (high lymphocytes in CSF)
* *cranial neuropathies + VERY low CSF glucose level
* Acid-fast bacilli stains and cultures are insensitive and may take up to 6 weeks to grow
87
Treatment for latent TB
- INH + rifapentine once weekly for 3 months
- 4 months of rifampin
- 3 months of INH + rifampin daily
88
treatment of gonorrhea
CTX + single dose of azithromycin (even if chlamydia negative due to growing resistance to CTX)
89
Finding on blood stain with babesiosis
intraerythrocytic tetrad forms (maltese cross)
90
Finding on blood stain with anaplasmosis and ehrlichiosis
Morulae (basophilic inclusion bodies)
91
Examples of TMAS
HUS
| TTP
92
Oral antibiotics that can be used for osteo
Ciprofloxacin
* Metronidazole
* both have excellent bioavailability and will penetrate bone adequately
93
Management of candidemia
Empiric treatment ASAP with echinocandin (anidulafungin, caspofungin, or micafungin) (high mortality rate)
- deescalate to fluconazole if susceptible for 14 day course
- receive CVC
94
recommended duration of treatment for vertebral osteo
6 weeks
95
Caveat about meningococcal vaccine
Quadrivalent vaccine doesn't include serogroup B, which accounts for 40% of meningitis, so could still have meningitis despite being vaccinated
96
Niesseria bacterial type
Gram-negative diplococci
97
Treatment of proctitis in patient at risk for sexually transmitted infections
CTX + doxycycline (often due to chlamydia and gonorrhea, and HSV)
98
Presentation of CMV
thrombocytopenia + organ-specific disease (CMV pneumonia, colitis, esophagitis, hepatitis)
99
Empiric treatment of CMV
Ganciclovir
100
How to determine risk of CMV in transplant patient
Serologic status of donor and recipient (high if donor or recipient are seropositive)
101
CMV pneumonia on CXR
diffuse bilateral lung involvement
102
Mortality/prognosis of CMV pneumonia
Poor prognosis, significant mortality
103
Management of MRSA bacteremia when vanc resistant
daptomycin
104
Management of patient with terminal complement deficiency
Meningococcal vaccination
Pneumococcal vaccination
Haemophilus influenza vaccine
105
management of mild, non purulent cellulitis
Clindamycin
Penicillin
Cephalexin
Dicloxacillli
106
organism in mild, non purulent cellulitis
streptococci
107
Clinical features of chronic granulomatous disease (CGD)
Recurrent or severe infections with aspergillum, staph aureus, nocardia, serratia
108
mycobacterium marinum clinical features
Granulomatous + skin infection (violaceous or erythematous papule or nodule that may ulcerate)
109
When bactrim can be discontinued for PCP prophylaxis
CD4>200 for more than 3 months
110
antibiotic duration for VAP
7 days
111
Anti-NMDA receptor encephalitis presentation
- Altered mood and behavior (psychosis) + seizures
- teratoma
- choreoathetosis
112
First step with patient presenting with TB
Obtain sputum for AFB's and culture BEFORE starting abx (need to perform susceptibility testing because resistance is increasing to isoniazid and rifampin)
113
Treatment + duration for active TB
RIPE for 8 weeks, then continue INH and rifampin for 18 weeks
114
Animals carrying nontyphoidal salmonella
Reptiles, amphibians
115
Management of persistent staph aureus bacteremia
Eval for source control issue (endocarditis, osteo, intra-abdominal infection) --> TTE, CT abdomen
116
Preferred antibiotic for MSSA
Cefazolin
117
Management of aeromonos hydrophila
- surgery
| - gram negative abx (doxycycline + ciprofloxacin)
118
When is bacterial transmission likely to occur with tick bites?
Only after 36 hours
119
Management of smallpox exposure
Vaccinia immunization
120
Next step for young patient with herpes zoster
Test for HIV
121
Sporadic creutzfeldt-jakob disease clinical features
Rapid progression of apparent dementia + ataxia + myoclonus + MRI abnormalities
122
CSF finding for creutzfeldt-jakob
14-3-3 T-tau protein
123
IDSA recommended antibiotic course for uncomplicated CAP
5-7 days (assuming defervescence for 48h and not validated if pseudomonas or staph RF's)
124
Initial imaging for suspected osteo
```
Plain radiography (low sensitivity but high specificity)
- Then MRI after if plain radiography negative
```
125
Workup of osteo if MRI contraindicated
Contrast-enhanced CT
126
Treatment of EHEC and why
Supportive (antibiotics will increase risk of HUS)
127
HUS presentation
MAHA + thrombocytopenia + kidney injury + more common in kids than adults
128
Prevalence of latent CMV in adults
60-90% (this is why disease reactivation is so common)
129
Highest risk of CMV scenario in transplant recipient
seronegative recipient receives organ from seropositive donor
130
CMV presentation
retinitis + pneumonitis + hepatitis + bone marrow suppression + colitis with bloody diarrhea + esophagitis + adrenalitis
131
First-line agent for CMV
valganciclovir
132
Evaluation of surgical site infection
Gram stain and culture of incision site drainage
133
Treatment of choice for cryptococcal meningitis
Liposomal amphotericin B + flucytosine
134
Treatment of oropharyngeal candidiasis + duration
Oral fluconazole (regardless of whether it extends into esophageus. If it does, need longer course (14-21 days)
135
Presentation of acute kidney infarction
flank pain or generalize abdominal Pain = N/V + hematuria + often cardioembolic from AF + wedge shaped perfusion defect on CT
136
Diagnosis of genital herpes
Nucleic acid amplification testing for HSV-1 and HSV-2
137
Treatment of nec fasc due to group A strep
Combined penicillin + clindamycin after surgical debridement
138
Toxic shock syndrome presentation
Hypotension + multiorgan involvement (kidney, liver, bone marrow (thrombocytopenia)).
139
Mediterranean spotted fever presentation
Fever + myalgia + HA + maculopapular and petechial rash
| ***black eschar at site of inoculation
140
Treatment of mediterranean spotted fever
7-10 day course of doxy
141
Clinical features of post transplant lymphoproliferative disorder
transplant patient who a few years after develops fever + pancytopenia + generalized lymphadenopathy + HSM
142
Pathogen in post transplant lymphoproliferative disorder
EBV
143
RF's for post transplant lymphoproliferative disorder
- pre-existing EBV infection
| - receiving sirolimus and tacrolimus compared to MMF and cyclosporine
144
When to think about PTLD
fever + LAD or extra nodal mass
145
PTLD treatment
Reduce immunosuppression
Rituximab (B-cell mediated)
Or other chemo
146
Worst infection to complicate transplantation
CMV
147
BK virus reactivation presentation
Gradual, asymptomatic increase in serum creatinine
148
Treatment of purulent skin infection (abscess or furuncle) with systemic signs of infection
IF systemic signs of infection --> I&D + bactrim or doxy (MRSA coverage)
IF mild and no signs of systemic infection --> just I&D per IDSA but there is evidence for antibiotics
149
What is a furuncle?
Purulent skin infection
150
patients for whom TST of 5 mm or greater should be considered positive
HIV
Recent known contact with person with active TB
Transplant patients
Immunosuppressed (TNF alpha antagonist or greater than pred 15 mg daily)
151
patients for whom TST of 10 mm or greater should be considered positive
- Person from endemic country
- IV drug user
- Residents or employees of high risk congregate settings (prisons and jails, nursing homes, other long-term facilities, hospitals or clinics, shelters)
152
latent TB treatment
INH + pyridoxine
153
Management + treatment of recurrent cystitis in women
- Urine culture (May be relapse or reinfection, most recurrences are reinfections (new bug))
- Cipro + levo
154
Definition of recurrent UTI
3 in past 12 months or 2 in past 6 months
155
Treatment of mucormycosis
Liposomal amphotericin B
156
Abx for purulent skin infection (MRSA coverage)
Doxy
| Bactrim
157
What is a furuncle?
Purulent skin infection
158
MSSA management in setting of orthopedic hardware
cefazolin + rifampin (synergistic)
159
Who needs to be quarantined from anthrax
Only people with direct exposure
160
CMV prophylaxis during transplant
Valganciclovir
161
When Cdiff typically occurs during transplant period
Early, first month
162
When CMV infection typically occurs
"middle" period, 1-6 months after transplantation
163
Presentation of Polyoma BK virus
Nephropathy + later than first month after transplantation
164
Management of polyoma BK nephropathy
Reduce immunosuppression to minimum level necessary to avoid rejection
165
First line treatment for pneumonic plague
Streptomcyin or gentamicin
166
pneumonic plague clinical features
- outbreaks among a group of people
| - severe pneumonia with hemoptysis
167
Gram staining + staining of pneumonic plague
- gram-negative coccobacilli
| - bipolar staining
168
Management of suspected pseudomonas
Dual therapy -- antipseudomonal B-lactam (zosyn, cefepime or meropenem) + quinolone or aminoglycoside
169
When to suspect pseudomonas
- immunocompromised patients
| - underlying structural lung disease (bronchiectasis or CF)
170
Preferred antibiotic for recurrent cystitis for which patient has received abx within the past 3 months OR in places where bactrim resistance rates are high
- quinolone -- cipro BID for 7 days (not first line due to SE's + rising resistance)
171
Preferred abx for cyclospora
bactrim
172
Cyclospora clinical features
- parasite typically acquired after consumption of fecal-contaminated food or water or fresh produce, particularly in developing world
- crampy abdominal pain, anorexia, bloating, decreased appetite, fatigue, fever/malaise/nausea/diarrhea
173
When it is safe to stop taking bactrim in HIV
CD4 count greater than 200 for more than 3 months
174
Aminoglycoside contraindication
Kidney disease
175
Post transplant lymphoproliferative disorder timeframe
- years after transplant
176
Indications for MRSA coverage with animal bites
- MRSA RF's in patient (previous MRSA infection or colonization)
- local MRSA prevalence is high
- pus forming
177
Management of smallpox exposure
- vaccinia immunization (even if immunocompromised, only don't give if severely immunodeficient)
178
Small pox vaccination
- we don't vaccinate kids against smallpox anymore because it's been declared eradicated so most of the population is not immune
179
Treatment of severe CDiff
- oral vancomycin (same as nonsecure)
180
Severe Cdiff vs. fulminant CDiff
- Severe = AKI or white count greater than 15K
| - Fulminant = complicated by ileum, hypotension, shock, or toxic megacolon
181
Preferred treatment of candida esophagitis
- fluconazole
(not nystatin swish and spit)
*Regardless of oral or esophageal involvement, esophageal just warrants a more prolonged treatment course (2 weeks rather than 1)
182
Cause of Ramsay Hunt syndrome
Varicella-zoster
183
Outpatient abx prophylaxis after HSCT and cell count recovery
Antifungal -- Posaconazole (risk of invasive fungal infection remains elevated even after recovery of neutrophils for the first few months)
Bactrim
*Don't need to continue acyclovir.
184
Use of valganciclovir during HSCT
Prevent or treat CMV infection
185
Why don't we prophylax for CMV?
- leukopenia is an SE of valganciclovir, so better to monitor for CMV and start therapy when indicated
