Infectious Diseases Flashcards
(118 cards)
1
Q
Investigations in suspected MRSA?
A
screening cultures
CXR
2
Q
Management of MRSA?
A
vancomycin/daptomycin/linezolid
3
Q
Features of C. Diff?
A
fever, nausea, abdo pain, watery diarrhoea
4
Q
Investigations in suspected C. Diff?
A
stool PCR for toxins A + B
5
Q
Management of C. diff?
A
vancomycin or fidaxomicin +/- metronidazole (if ileus present)
6
Q
When should klebsiella pneumonia be considered?
A
Aspiration pneumonia
Alocholics
Abscess in the lungs
7
Q
Common causes of pneumonia?
A
s. pneumoniae, h. influenzae, s. aureus, GAS
8
Q
Signs of pneumonia?
A
Consolidation (crackles, dull to percuss, bronchial breath sounds)
9
Q
Ix pneumonia?
A
- Bloods
- serum gram stain (C + S), blood C+S
- pleural fluid (C+S) IF effusion over >5cm or resp. -distress
- CXR
- bronchoscopy/washings if very ill/refractory to Tx
10
Q
Criteria for hospitalisation w/ suspected pneumonia?
A
CURB 65 or PSI (pneumonia severity Index)
11
Q
CURB-65 Score
A
Confusion Urea 7mmol/L or BUN >20mg/dL RR >30 sBP <90 or dBP <60 age 65+ (0-1 point treat outpt, 2-3 consider hospital, 4-5 consider ICU)
12
Q
Management of CAP?
A
outpt: amoxicillin OR doxycycline OR macrolide (cliarithromycin)
inpatient: Beta lactam (ceftriaxone) +/- macrolide
13
Q
Management of HAP?
A
piperacilllin - tazobactam
14
Q
Prevention of pneumonia?
A
pneumococcal polysaccharide vaccine: all adults 65+ or younger pts at high risk for invasive pneumococcal disease
pneumococcal conjugate vaccine for 5-17 yr at high risk and has not received the conjugate vaccine
15
Q
Types of influenzae strains?
A
strain A (humans, birds, mammals) strain B (humans only)
16
Q
Features of influenzae?
A
Systemic (fever, chill, myalgia)
Resp (cough, dyspnoea, pharyngitis)
typically resolve 7-10 days
17
Q
Ix in influenzae?
A
primarily clinical
nasopharyngeal swabs for RT- PCR
18
Q
Tx of influenzae?
A
Supportive
Neuraminidase Inhibitors (oseltamivir/ zanamivir) - IF severe/high risk for complications
19
Q
Common causes of cellulitis?
A
B-hemolytic streptococci
20
Q
Ix cellulitis?
A
CBC + differential
blood C+S
skin swab (if open w/ pus)
21
Q
Tx cellulitis?
A
cephalexin
consider IV cefazolin
22
Q
Features of nec fasc?
A
pain out of proportion
edema + crepitus + fever
necrosis
23
Q
Ix in nec fasc?
A
clinical Dx
blood + tissue C+S
serum CK
X- ray
24
Q
Tx nec fasc?
A
surgical debridement
IV fluids
IV antibiotics
25
Features of oral candidiasis?
white patches + can be wiped off w/ erythematous base
red patches localised to palate + dorsum of tongue
26
Tx oral candidiasis?
topical antifungals
27
Features of gonococcal arthritis?
arthralgia
bacteremia Fx
pustular skin lesions and migratory arthralgias (if disseminated)
28
Features of septic arthritis?
acute onset, non wt bear, swelling/warmth often in large weight bearing joints + wrists
29
Ix in septic arthritis?
gonococcal: blood C+S, endocervical/urethra/rectal swabs
non-gonococcal: Blood C+S
arthrocenteisis (synovial fluid analysis)
CBC w/ diff
gram strain
30
Management of septic arthritis?
empiric IV: cefazolin +/- vancomycin
gonococcal: ceftriaxone
31
Management of diabetic food infections?
mild/mod: cefazolin/cephalexin
severe: ceftriaxone+metronidazole
optimise glycemic control, pressure offloading, wound care
32
Causes of infective endocarditis?
native valve - streptococcus
| IVDU - s. aureus
33
Fx of infective endocarditis?
systemic
cardiac: CHF - MR, AR
embolic/vascular: splinter haemorrhages, janeway lesions, splenomegaly
immune: osler nodes, glomerulonephritis, arthritis
34
Dx of infective endocarditis?
Dukes Criteria
2 major OR 1 major + 3 minor OR 5 minor
MAJOR: all positive blood cultures, evidence of endocardial involvement
```
MINOR:
predisposing condition
fever
vascular/ immune signs
positive blood culture
```
35
Ix of infective endocarditis?
BC x3 (different sites over 1hr apart)
bloods: anemia, ESR increased, RF+
urinalysis + C/S
ECHO: vegetation, regurgitation, abscess
36
Rx for infective endocarditis?
native valve: vancomycin + gentamicin / ceftriaxone
prosthetic valve: vancomycin + gent + rifampin
surgical
37
When do pts need prophylactic ABx in prev infective endocarditis?
if high risk +
dental/respiratory procedure (amoxicillin or clindamycin)
skin/soft tissue procedure (cephalexin or clindamycin)
38
Common organisms in meningitis (age 0-4 wks)
GBS
e. coli
L. monocytogenes
39
Common organisms in meningitis (age 1-3mo)
GBS
40
Common organisms in meningitis (age >3m)
s. pnuemoniae
N. meningitiditis
L. monocytogenes (if over 50 + cormorbid)
41
Ix in meningitis?
CBC, eletrolytes, blood C+S
CSF
imagining/neuro studies if focal neurological signs
42
Gram stain for S. pneumoniae?
Gram + diplococci
43
Gram stain for N. meningitidis?
Gram - diplococci
44
Gram stain for L. monocytogenes?
Gram + rods
45
CSF findings for bacterial vs viral causes?
Bacterial: high protein, low glucose, neutrophils
Viral: high protein, normal glucose, lymphocytes
46
Management of meningitis (age 0-4 wks)
ampicillin + cefotaxime
47
Management of meningitis (4 wks - <3m)
ceftriaxone + ampicillin + vancomycin
48
Management of meningitis (>3m)
ceftriaxone + vancomycin
| + ampicillin (IF RF for L. monocytogenes)
49
When is IV dex used in meningitis?
within 20 min prior or w/ 1st dose ABx
| continue if proven pneumococcal meningitis
50
Post exposure prophylaxis in meningitis?
h. influenzae - rifampin (if not adequately immunized or immunocompromised)
n. meningitidis - rifampicin, ciprofloxacin
51
Rx of encephalitis?
```
supportive care
IV acyclovir (until HSV encephalitis ruled out)
```
52
Features of tetanus?
trismus / lockjaw
contraction of skeletal muscle w/ periods of painful muscle spasms
paralysis
HTN/tachycardia/pyrexia
53
Rx of tetatus?
wound debridement
IV metronidazole OR IV pen G
tetanus immuneglobulin
54
Prevention of tetanus?
toxoid vaccine
55
Management of rabies if not previously immunized?
wound care
passive immunization: immunoglobulin
active: inactivated human diploid cell rabies virus vaccine - 4 shots post exposure
56
Management of rabies if previously immunized?
wound care
| two doses of inactivated human diploid cell rabies virus vaccine
57
qSOFA score
RR 22+
systolic BP <=100
GCS <15
58
septic shock definition
persistent hypotension requiring vasopresins + serum lactate >2 mmol/L
59
Management of sepsis?
```
resp support
CVS support
IV antibiotics
Source control
Hydrocortisone IV if unresponsive to fluid resus/vasopressors (norepinephrine)
```
60
Fx of leprosy?
chronic granulomatous disease
- tuberculoid type: less lesions, well defined
- lepromatous type: multiple lesions, facies
61
Ix in leprosy?
skin biopsy for AFB staining
| PCR (Mycobacterium leprae)
62
Cause of lyme disease in N. america?
Borrelia burgdorferi transmitted by ticks
63
Fx of lyme disease?
```
BAKE
Bell's palsy
arthralgia
kardiac block
erythema migrans: non itchy bulls-eye lesion
(stage 1: rash and malaise)
(stage 2/3: systemic involvement)
```
64
Tx of lyme disease?
doxycycline
65
Causes of toxic shock syndrome?
staphylococcus or streptococcus
66
Rx of toxic shock syndrome MSSA and MRSA?
MSSA: clindamycin + cloxacillin
MRSA: clindamycin + vancomycin
67
Rx of toxic shock syndrome streptococcal?
penicillin + clindamycin
68
Bug that causes cat scratch disease?
Bartonella henselae (GN bacilli)
69
Fx of cat scratch disease?
malaise, fever
| disseminated: organomegaly, lymphadenopathy, retinitis,IE, encephalopathy, uveitis
70
Tx of cat scratch disease?
Azithromycin
71
Cause of rocky mountain spotted fever?
Rickettsia rickettsii
72
Fx of rocky mountain spotted fever?
flu like prodrome
| macular rash d2-4 starting on wrists/ankles then spread centrally
73
Rx of rocky mountain spotted fever?
doxycycline
74
Cause of syphilis?
treponema pallidum
75
Fx of syphilis?
1: chancre
2: maculopapular rash, condylomata lata
3 (tertiary): nodular granulomas, aortic aneurysm/AR
4: neurosyphilis - argyll robertson pupil
76
What is argyll robertson pupil?
accomodates but does not react to light
77
Rx for syphilis?
Benzathine penicillin G
78
Types of TB?
Pulmonary type
Miliary type
Extra-pulmonary
79
Fx of pulmonary TB?
```
productive cough
non- resolving pneumonia
haemoptysis
night sweats
wt loss, CP
```
80
Fx of miliary TB?
widely disseminated spread to other organs
81
Ix for latent TB?
tuberculin skin test - >10mm induration is + test
82
Ix for active TB?
- CXR: apical infiltrates, lung volume loss, cavitation, Ghon complexes
- sputum samples: acid fast bacilli smear
+/- BAL (if other pathology also suspected)
83
Rx of active TB?
```
RIPE
Rifampin
Isoniazid (+ pyridoxine)
Pyrazinamide
Ethambutol
```
84
Primary prevention of TB?
BCG vaccine
85
HIV acute infection features?
non specific illness
| heme: lymphopenia, thrombocytopenia
86
Initial screening test for HIV?
ELISA for anti-HIV antibodies (3mo period before detectable)
87
Conformation test for HIV?
Western blot
88
Why does the CD4 count and viral load matter in HIV?
CD4 - progress and stage of disease
| Viral load - rate of progression
89
What vaccines are recommended for HIV+ pts?
flu yearly
pnuemococcal every 5 yrs
HBV + HAV if not immune
HPV
90
Overall Rx for HIV + pts?
reduce viral load
| 2NRTIs + 1INSTI or protease inhibitor
91
Ix in Pneumocystis jirovecii pneumonia?
CXR: bilat. interstitial infiltrates
ABG: reduced pO2, increased alveloar arterial gradient
serum LDH: elevated
PCR
92
Rx of PJP Pneumonia?
trimethoprim - sulfamethoxazole
93
What fungi can be inhaled from pigeon droppings?
Cryptococcus neoformans
94
Features of cryptococcus spp?
```
opportunistic fungi - think HIV
Raised ICP (abducens palsy)
```
95
Ix of cryptococcus spp?
LP and indian ink stain
| antigen test
96
Rx of aspergillus spp?
voriconazole or amphotericin B
| surgical resection if aspergillioma
97
Causes of malaria?
plasmodium species
98
Features of malaria?
flu like prodrome
high spiking fevers + shaking chills
hepatosplenomegaly + thrombocytopenia without leucocytosis
99
Most lethal type of malaria?
Plasmodium falciparum
- CNS involvement
- ARDS
- AKI
100
Ix in malaria?
CBC: thrombocytopenia, anemia, elevated LDH
microscopy: blood smear x 3
rapid antigen / PCR
101
Management of malaria?
chloroquine
102
Exposure to what causes toxoplasma gondii?
cat feces
| ingestion of undercooked meat
103
Features of toxoplasma gondii?
immunocompetent - mononucleosis like syndrome
immunocompromised - encephalitis
Ring enhancing lesions on CT
104
Ix in toxoplasma gondii?
serology
CSF wright-giemsa stain
antigen or PCR
105
Rx in toxoplasma gondii?
Trimethoprim -sulfamethoxazole if immunocompromised
106
Features of ascaris lumbricoides?
Roundworm
| intestinal blockage, pul infiltrates
107
Features of trichuris trichira?
whipworm (roundworm)
diarrhoea
abdo pain
108
Features of strongyloids stercoralis?
threadworm (roundworm)
pruritic dermatitis
abdominal pain, diarrhea, pruritis ani
109
Rx of roundworms?
mebendazole
albendazole
ivermectin
110
What flatworm is found in undercooked pork?
Taenia solium
111
What flatworm is found in undercooked beef?
taenia saginata
112
What flatworm is found in raw fish?
diphyllobothrium latum
| common in great lakes
113
Features of diphyllobothrium latum?
b12 deficiency
114
Rx of flatworms?
Praziquantel
115
What flatworm can be found in fresh water?
Schistosoma species
116
Features of schistosoma spp infection?
```
Swimmers itch
Acute schistosomiasis (Katayama) - hypersensitivity reaction
```
117
Features of chronic schistosomiasis infection?
Neurological manifestation
| Pulmonary manifestation
118
Most common causes in returning traveller?
malaria (parasite)
viral - mononucleosis like syndrome, hepatitis
salmonella
