INFECTIOUS DISEASES Flashcards

Question

CCS CASE COMPLICATED OMA MASTOIDITIS 27 MALE COME TO THE OFFICE A WEEK AFTER INITIAL VISIT FOR EAR PAIN AND DECREASE HEARING . HE WAS COMPLIANT WITH AMOXICILLIN THAT YOU HAD PRESCRIBED IT TO HIM FROM WEEK AGO. HE COMES NOW BECAUSE WORSENING PAIN AND DETERIORATION AF HEARING.

Answer 1

Order >> complete PE >> temp 38, bulging red tympanic membrane, intact membrane, tender Pinna, which displaced inferiorly and laterally. Area abive the pinna is tender and Small ﬂuctuate mass. Order • CBC • BMP • Plain x ray of mastoid process>>> obliteration of mastoid air cells and destruction of trabecular mesh work. • CT of mastoid process >> massive destruction and subperiosteal collections. • Tympanocentesis and culture >> Strep. pneumonia. • Mastoid biopsy is the most sensitive test. Order • IV penicillin only for pen sensitive pneumococcal infection • Pen resistant >> cefotaxime or Ceftriaxone • Vancomycine for one resistant.

Answer 2

ORDER COMPLETE PE 38.6 C BP 90/60, HR 100, SCLERAL ICTERIC, RUQ TENDERNESS,MILD REBOUND TENDERNESS WELL HEALED SCAR IN RIGHT HYPOC ORDER: • Oxy, Pulse oxy • IV access, NSS • NPO • IV AMPICILLIN/SULBACTAM if allergic to pen use AZTREONAM + METRONIDAZOL COVER GRAM NEG • EKG • CARDIAC MONITORING • CBC • BMP>> BUN high, • FIBRINOGEN • BLOOD CULTURE • URINE ANALYSIS • URINE CULTURE • LFT>> bilirubin 4 (hi) , alk 300 (hi), rest are N. •ABDOMINAL USG >> DILATED COMMON BILE DUCT >> NO MASSES. ORDER: * ADMIT TO WARD * CONSULT SURGERY * Order ERCP TO REVIEW THE STONE FROM BILE DUCT IF FAILED EXPLORATORY LAPAROTOMY

Answer 3

Order Complete PE>>> Temp 39, thin, lying on stretcher, petechia on his mouth and conjunctiva. Bilateral clear.thin red lines on his ﬁngernails. Order • Pulse oxy • Oxygen • IV access >>> Normal saline • Cardiac monitoring Order • CBC • BMP • UA • Blood culture >>> MSSA >>> • Urine culture • IV Vancomycin + gentamycin • CXR >>> multiple Nodular lesion bilateral • Echo >>> vegetation Order • Admition • Nafcillin+Genta for 6 wks coz vegetations.

Answer 4

ox honey down crusted lesions on erythema tours base Nothing to be done >> this is classical distribution of impetigo causative organism strep pyogenes ORDER: Topical Mupirocin if not oral dicloxacillin & nafcillin. Pen allergy erythromycin s or azithromycin. RETAPAMULIN TOPICAL ABX ONLY FOR IMPETIGO

Answer 5

PRIMARY ANSWER: DO DARKFIELD 25% IN PRIMARY LUES SERONEGATIVES ``` DARK FIELD MOST SENSITIVE VDRL RPR 75% FTA-Abs TTX: SINGLE IM PCN G ALLERGY: DOXY ``` SECONDARY ``` DARK FIELD VDRL RPR 99% FTA TTX: SINGLE IM PCN G ALLERGY: DOXY ``` TERCIARY ``` DARK FIELD VDRL RPR 50 % FTA SENSITIVITY 100% EN CSF 75% IN BLOOD TTX: IV PENIC G ALLERGIES:DESENSITIZE ``` CCS "2 MIN" SCREEN FOLLOW UP: "LATER" RPR/VDRL TO LOW DO NOT USE TREPONEMAL TEST FTABS EIA LIFELONG REACTIVITY

Answer 6

NEUROSYPHILIS | PREGNANT

Answer 7

WARTS: PODOFILOX: CITOXIC ANTIMYCOTIC IMIQUIMOD IF NO RESUELVE: PODOPHILIN RESIN TCA ``` THEN: SURGERY: IF> 1CM REDUCE W/ TCA PODOPHILIN THEN EXCISION CRYO, LASER, TRICHLOROACETIC ACID. ``` FU: RECURRENCE PREGNANCY: TCA SURGERY DO NOT USE PODOPHILIN, PODOFILOX, FU TEERATOGENIC

Answer 8

PERMETHRINA: BOTH IVERMECTINE: SCABIES LINDANE : BOTH PYRETHRINES PEDICULOSIS

Answer 9

FOSFOMYCIN NITROFURANTOIN 3d SAFE IN PREGNANCY CLASS B E COLI RESISTANCE >20% LEVO OR CIPRO COMPLICATED MEANS STONE STRICTURE TUMOR OBSTRUCTION: TMP-SMT 7 d

Answer 10

DO NOT TREAT | JUST IN PREGNANCY AND PREVIOUS AN INSTRUMENTATION

Answer 11

``` DO US R/O PERINEPHRIC ABSCESS BIOPSY COVER SELECTED OUT GRAM POSITIVES VANCO NAFCILLIN OXACILLIN ```

Answer 12

BEST INITIAL TEST: UA MAT: WBC PROST MASSAGE CIPRO TMP-SMT FOSFOMYCIN

Answer 13

AZYTHRO TOC* NO MEJORA ? IF COMPLIANCE NOR REINFECTION DO METRONIDAZOL TRICHOMONAS NO MEJORA ? RESISTANT NGU ERYTHROMYCIN 800 MG / 6 TIMES A DAY

Answer 14

NO! ABS ARE TYPICALLY SEEN IN n 7-10 DYS AFTER ONSET REPEATING WOULD DELAY TREAT EMPIRICALLY DOXY PREGNANCY CLORANFENICOL

Answer 15

``` CD4 < 500 -350 CD4 > 500 VIRAL LOAD DETECTABLE - 50,000 BY PCR PREGNANCY ANY CD4 ANY STAGE NEEDLE STICK INJURY SYMPTOMATIC PTS ANY CD4 OR VIRAL LOAD ```

Answer 16

NUCLEOSIDE: LACTIC ACIDOSI PI HYPERGLICEMIA HYPERLIPIDEIMIA NON NUCLEOSIDE DROWSISSNESS AVOID MENTAL ILNESS INTEGRASE INHIBITORS

Answer 17

``` NUCLEOSIDES: ZIDOVUDINE: ANEMIA DIDASONIDE/ STAVUDINE: PANCREATITIS NEUROPATHY ABACAVIT HLA B 5701 RASH TENOFOVIR RTA RENAL TOX NEUROPATHY BONE DEMINERALIZATION ``` PI: INDINAVIR: KIDNEY STONES

Answer 18

NUCLEOSIDE: LACTIC ACIDOSIS PI HYPERGLYCEMIA HYPERLIPIDEIMIA NON NUCLEOSIDE DROWSINESS AVOID MENTAL ILLNESS INTEGRASE INHIBITORS

Answer 19

NUCLEOSIDES: ``` ZIDOVUDINE: ANEMIA DIDASONIDE/ STAVUDINE: PANCREATITIS NEUROPATHY ABACAVIT TEST FOR HLA B 5701 = RASH TENOFOVIR RTA RENAL TOX NEUROPATHY BONE DEMINERALIZATION ``` PI: INDINAVIR: KIDNEY STONES

Answer 20

MFAGE: CCR5 - Gp 120 ENTRY INHIBITOR BOST DRUG LEVELS ADD TO HARRT BOOST LEVEL OF OTER PI s BY P450 INTERACTION

Answer 21

TENOFOFOVIR EMTRICITABINA+ PI ATRAZANAVIR + RITO TENOFOVIR EMTRICITABINA+ INTEGRASE INHIBITOR LAMIVUDINE ABACAVIR + INTEGRASE INHIBITOR

Answer 22

RING OR CONTRAST ENHANCING LESIONS PYRIMETAMINE + SULFADIAZINE REPEAT CT SCAN 2 WK IF NOT LYMPHOMA CNS BIOPSY IT CAN USE ATOVAQUONE INSTEAD PYRIMETHAMINE

Answer 23

PCPPr: CD4 200 TMP-SMX BY FAR USMLE FAVORITES PrSCENARIOS: ATOVAQUONE IF RASH TMP-SMX DAPSONE G6PD PENTAMIDINE AEROSOLIZED LESS EFFICACY PCP CCS: ``` IV TMP-SMX IV PENTAMIDINE CLINDAMICINA PRIMAQUINA IF RASH ATOVAQUONE FOR MILD CASES PaO2 70 mm 35 A-a STEROID ```

Answer 24

Pr TOXOPLASMOSIS CD4 < 100 DO IgG SEROLOGY FOR TOXOPLASMOSIS GIVE TMP/SMX RING OR CONTRAST ENHANCING LESIONS DO IgG SEROLOGY TOXOPLASMA EMPIRIC PYRIMETHAMINE + SULFADIAZINE REPEAT CT SCAN 2 WK RESOLUTION? FU LIFELONG TMP/SMX D/C IF CD4> 200 RING ENHANCING LESIONS PERSISTS LYMPHOMA CNS BIOPSY IT CAN USE ATOVAQUONE INSTEAD PYRIMETHAMINE

Answer 25

CD4 < 50 AZITHRO MAI Pr = AZITHRO 1200 mg ONCE /WK PO DX ORDER: BLOOD CULTURE LEAST SENSITIVITY BONE MARROW MORE SENSITIVE LIVE BX THE MOST SENSITIVE ``` TTX- CCS MAI AZYTHROMICIN OR CLARYTHROMCIN INSTEAD RIFAMPICIN ETHAMBUTOL ADD RIFABUTIN ``` PPD >5 mm EVALUATE AND TREAT FOR EITHER ACTIVE OR LATENT TB

Answer 26

``` DX: DILATED FUNDOSCOPIC EXAM ORDER: IV GANCICLOVIR : LOW WBC FOSCARNET :HIGH CREATININE ``` Pr VALGANCYCLOVIR UNLESS HART CD4 RISES PO FLUCONAZOL PO DIFLUCAN REFRACTORY PERSISTENT

Answer 27

DX: ``` CSF ANALYSIS : LYMPHOCYTES SENSITIVITY INDIA INK 60% CRYPTOCOCAL ANTIGEN 95% ``` AMPHOTERICINE + 5 FC FOLLOWED BY FLUCONAZOL Pr LIFELONG FLUCONAZOL UNLESS CD4 RAISES

Answer 28

``` HIV< 50 BEST NEXT STEP MRI-CT SCAN FOR WHITE MATTER LESIONS PCR CSF FOR CJ HAART ```

Answer 29

``` MAJOR CRITERIA 2 BLOOD CULTURES + POSITIVE ECHO = INFECTIVE ENDOCARDITIS BEST NEXT STEP USMLE: FEVER+ NEW MURMUR+ BLOOD C S IF BLOOD CS POSITIVE DO ECHO-CARDIOGRAM IF TTE ECHO IS NEGATIVE DO TEE SENSITIVITIES 60% VS 95% SPECIFICITY EQUAL 95% ```

Answer 30

COXIELLA BARTONELLA ARE MCC CULTURE NEGATIVE ENDOCARDITIS THAN HACEK CLOSTRIDIUM SEPTICUM MCC THAN STREP BOVIS ORDER COLONOSCOPY

Answer 31

DO 4-6 WK IV TTX DO NOT NEED TO COVER GNR EMPIRIC: VANCO+GENTA OR (CEFTRIAXONE) ``` LEARN ONE: IN MRSA VANCO DAPTOMICIN IN MSSA NAFCILLIN ```

Answer 32

TRANSPLANTS PATIENT WHO DEVELOPED VALVULAR DZ PROSTHETIC VALVES UNREPAIRED CARDIAC CYANOTIC MALFORMATIONS PREVIOUS ENDOCARDITIS DOC: AMOXICILLIN ALLERGIES: CLINDAMYCIN or AZITHRO/CLARITHRO JUST RASH: CEPHALEXIN

Answer 33

``` TULAREMIA TRICHINELLOSIS Under-cooked meat Myalgia Dx (Eosinophils + CK MM + ELISA) Albendazol Mebendazol PLAGUE Fever HA Myalgia Massive LAD Buboes Aspirate MAC Culture Streptomycin Gentamycin Doxycicline. Lung is fatal STRONGILOIDES CYSTICERCOSIS Albendazol BRUCELLAS CHAGAS ANTHRAX BARTONELLA ``` ``` TICK: RMSF LYME BABESIA ERLICHIA/ANAPLASMA MALARIA ``` FUNGAL AND ATYPICAL ``` NOCARDIA ACTYNOMICES HYSTOPLASMOSIS COCCIDIOMYCOSIS BLASTOMYCOSIS MUCORMYCOSIS DKA Deferoxamine Surgery + IV Amphotericin FU: Posaconazol Isavuconazol ASPERGILLUS CANDIDA auris Bloodstream IC Resistant Fluconazol Voriconazol Tx: Echinocandins Caspofungin Micafungin ``` TROPICAL DISEASE AND PARASITES DENGUE HF NST ELISA EBOLA HF Airborne? NO!!! Direct Contact PCR CHIKUNGUYA RNA virus Toga Aedes Joint Pain Arthralgia y Rash PCR NST ZIKA Microcephaly GB association Acetaminophen and Fluids NST CRIMEAN CONGO RNA HF Ticks ELISA PCR Rivabirin LEISHMANIOSIS Direct + PCR to confirm liposomal Anphothericine Miltefosine ECHINOCOCCUS Albendazol Alcoholization cyst BEDBUG MID EASTERN RESPIRATORY SYNDROME Coronavirus Airborne Middle East Arabia Saudi ARDS fatal CHOLERA OK

Answer 34

CAMPING / HIKING + RASH = LYME = DOXYCICLINE RASH IS ENOUGH PO alternatives: Pregnant: Amoxicillin Cefuroxime MANIFESTATIONS NEED CONFIRMATION: IgM IgG ELISA confirm WESTERN BLOT OR PCR JOINT CARDIAC CNS 4 USMLE: RASH JOINT BELL PALSY DOXYCICLNE CNS OR CARDIAC (AV BLOCK) CEFTRIAXONE

Answer 35

MILD MALARIA AND Pr MALARIA : MEFLOQUINE Neuropsychiatric effects bradycardia and QT prolongation ARTOVAQUONE/PROGUANIL IV QUININE/DOXYCICLINE TREAT SEVERE MALARIA WITH ARTEMISINS DERIVATES ARTEMETHER ARTHESUNATE AS IV QUININE PROLONGS QT AND HAS LESS EFFICACY SEVERE MALARIA: ARTEMETHER ARTHESUNATE ``` PARASITEMIA > 5 % HYPOGLYCEMIA CNS HIGH CREATININE METABOLIC ACIDOSIS ``` USMLE FAVORITE: G6PD BEFORE PRIMAQUINE REMEMBER DAPSONE IN PCP

Answer 36

MSSA OXACILLIN NAFCILLIN CEPHAZOLIN MRSA ``` BLOOD STREAM: LINEZOLID: LOW PLATELETS DAPTOMICIN: MYOPATHY VANCOMICIN CEFTAROLINE ``` ``` MINOR CLINDAMICIN TMP-SMZ DELAFLOXACIN TIGECYCLINE ``` ``` ESBL HA INFECTIONS CARBAPENEM CEPHALOSPORIN BETALACTAMASE INHIB CEFOLOZANE-TAZO CEFTAZIDIMA-AVIBACTAM ```

Answer 37

PCN AMPICILLIN AMOXICILLIN

Answer 38

QUINOLONE FOR PNA MRSA SKIN GNR

Answer 39

CEFEPIME CEFTAZIDIMA PIPERACILINA TICARCILINA AZTREONAM CIPROFLOXACINO LEVOFLOXACINO MOXIFLOXACINO GEMIFLOXACINO GENTAMYCIN TOBRAMYCIN AMIKACIN IMIIPENEM ERTAPENEM MEROPENEM DORIPENEM

Answer 40

BELLOW DIAPHRAGM METRONIDAZOL SAME EFFICACY THAN METRONIDAZOL: CARBAPENEM: IMIPENEM SEIZURES TICARCILINA PIPERACILLIN ONLY CEPHALOSPORIN COVERS ANAEROBES CEFOXITINA CEFOTETAN ABOVE DIAPHRAGM: RESP ANAEROBES STREP CLINDAMYCIN

Answer 41

3 YEARS AFTER THE ONSET OF SEXUAL INTERCOURSE OR 21 YO WHICHEVER EARLIER IF 3 CONSECUTIVE NEGATIVES CONSIDER INCREASING THE INTERVAL BETWEEN CYTOLOGY SCREENING 2 TO 3 YRS IF NOT CIN 2 OR CIN 3 -IMMUNE COMPROMISE -HIV INFECTION OR IN UTERO EXPOSITION TO DIETILETHILBESTROL DO NOT SCREEN WOMAN WHO ARE NEGATIVE FOR BOTH HP DNA AND CYTOLOGY BEFORE 3 YRS REPEAT HPV DNA TESTING AND CYTOLOGY EVERY 6 -12 MONTHS IN HIGH RISK WOMAN OR HPV DNA POSITIVE. DISCONTINUE: HYSTERECTOMY FOR BENIGN PROCESS OR 65 TO 70 YO WITH NEGATIVE RECENT ADEQUATE CERVICAL CYTOLOGY SCREENING

Answer 42

SCREEN FOR VDRL / RPR CHLAMYDIA GONORRHEA DNA PROBE NAAT URINE BASELINE GENOTYPE HAART IS OPTIONAL IN ARS DON'T FORGET CCS 2 MIN SCREEN HEPATITIS A HEP B PNEUMOCOCCAL VACCINES EVERY 5 YR INFLUENZA ANNUAL NOTIFY HEALTH PUBLIC HIV SUPPORT GROUP SAFE SEX TREAT PARTNER

Answer 43

USE C-SECTION NO BREASTFEEDING ONLY FORMULA FEEDING HAART THERAPY DURING PREGNANCY AND LABOR

Answer 44

ORDER BLOOD CULTURES AND LUMBAR PUNCTION STAT AVANCE CLOCK 1 MIN NOT IN THE SAME SCREEN DEXAMETHASONE 15 MIN BEFORES 1 ST DOSE OF EMPIRIC ANTIBIOTICS ORDER PROTEIN GLUCOSE CELL COUNT GRAM STAIN AND BACTERIAL CULTURES CSF PCR FOR ENTEROVIRUS AND HSV IF BACTERIAL GRAM STAIN AND CULTURE ARE NEGATIVE "ASEPTIC MENINGITIS" CT SCAN BEFORE LP IF: ``` IMMUNE COMPROMISED HISTORY OF CNS DISEASE NEW ONSET SEIZURE PAPILEDEMA ALTERED LEVEL OF CONSCIOUSNESS FND ``` NEGATIVE CT SCAN >>> PERFORM LUMBAR PUNCTURE CSF ANALYSIS: CSF FINDINGS CONSISTENT WITH BACTERIAL MENINGITIS CONTINUE OR STOP ABXS

Answer 45

ABSOLUTE NEUTROPENIA < 500 COVER GRAM NEGATIVE WITH CEFEPIME OR IMIPENEM IF VERY CRITICALLY ILL OR MRSA RISK ADD VANCOMYCIN IF NO RESPONSE I 48 HOURS ADD ANTIFUNGALS

Answer 46

ABSOLUTE NEUTROPENIA < 500 COVER GRAM NEGATIVE WITH CEFEPIME OR IMIPENEM IF VERY CRITICALLY ILL OR MRSA RISK ADD VANCOMYCIN IF NO RESPONSE I 48 HOURS ADD ANTIFUNGALS

INFECTIOUS DISEASES Flashcards

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