Infectious Diseases Flashcards
(171 cards)
1
Q
Antibiotics for in-patient tx of Community-acquired pneumonia.
A
Ceftriaxone + Azithromycin
*B-lactam allergy: moxifloxacin
2
Q
Antibiotics for out-patient tx of Community-acquired pneumonia.
A
Azithromycin, doxycycline
*B-lactam allergy: moxifloxacin
3
Q
Antibiotics for healthcare-associated pneumonia.
A
Vancomycin + Piptazo
or
Linezolid + Meropenem
Key: MRSA or Pseudomona
4
Q
Antibiotics for Meningitis
A
Vancomycin + Ceftriaxone 2gr BID + Steroids
*If immunocompromised: Ampicillin
5
Q
Antibiotics for outpatient UTI
A
Amoxicillin Or Ampicillin Or Tmp-smx
*If b-lactam allergy: nitrofurantoin
6
Q
Antibiotic for Pyelonephritis
A
ceftriaxone
7
Q
Antibiotic for out-patient strep cellulitis
A
Amoxicillin
8
Q
Antibiotic for in-patient strep cellulitis
A
ceftriaxone
9
Q
Antibiotic for out-patient staph cellulitis
A
Clindamycin, cefazolin
10
Q
Antibiotic for out-patient staph cellulitis
A
vancomycin
11
Q
Patient with Flu-like sx, myalgias, arthralgias, lymphadenopathy, fever.
• Flu (-), mononucleosis (-)
• HIV ELISA (-)
Dx, next step, tx?
A
Antiretroviral syndrome
Next step: PCR (viral load)
Tx: HAART (2+1)
12
Q
Patient with opportunistic infection, HIV ELISA (+)
Next steps, tx?
A
Confirmation HIV with western blot
Other tests:
o Viral load (decreases quickly with tx)
o CD4 count (slowly increases only 300 of start point)
o Genotype (“culture”)
o Screen for gonorrhea, chlamydia, syphilis, HBV, HCV, toxoplasma.
Tx: HAART 2+1 depending on genotype
13
Q
What is HAART 2+1?
A
2 nucleoside reverse transcriptase inhibitors (NRT-i) plus 1 of the following:
• Non- nucleoside reverse transcriptase inhibitors (NNRT-i)
• Protease inhibitor (P-i)
• Entry inhibitor
• Fusion inhibitor
14
Q
Meds for PrEP?
A
Tenofovir + Emtricitabine
15
Q
Meds for post-exposure prophylaxis (PEP)?
A
Tenofovir + Emtricitabine +/- Raltegravir
16
Q
Vertical transmission prophylaxis of HIV?
A
- Mom on HAART 2+1
* If unknown before: AZT
17
Q
Prophylaxis of PCP pneumonia in HIV?
A
- Tmp-smx
- Dapsone
- Atovaquone
18
Q
Prophylaxis of toxoplasmosis pneumonia in HIV?
A
- Tmp-smx
2. Pyrimethamine + leucovorin
19
Q
Prophylaxis of Mycobacterium avium complex (MAC) pneumonia in HIV?
A
Azithromycin
20
Q
Tx of Thrush in HIV?
A
Nystatin
21
Q
Tx of Pneumocystis (PCP) pneumonia in HIV?
A
Tmp-Smx, dapsone
22
Q
Tx of Crypto meningitis in HIV?
A
Amphotericin + fluticasone
23
Q
Tx of Esophageal candidiasis in HIV?
A
Fluconazole
24
Q
Tx of HSV Esophagitis in HIV?
A
Acyclovir
25
Tx of CMV Esophagitis in HIV?
ganciclovir
26
Tx of Toxoplasmosis in HIV?
Pyrimethamine sulfadoxine
27
Tx of Disseminated Mycobacterium avium complex (MAC) in HIV?
Clarithromycin + ethambutol
28
Tx of CMV retinitis in HIV?
Valaciclovir, foscarnet
29
Patient with close contacts, HIV/AIDS, Transplants, Chemo. How much is a positive PPD?
> 5mm
30
Prisoners, Homeless, Healthcare worker, Traveled to endemic area. How much is a positive PPD?
> 10 mm
31
Western patient with no risk factor. How much is a positive PPD?
> 15 mm
32
TB screening.
+ PPD
- CRx
Dx and next step?
Latent TB
INH + B6 x 9 months
33
TB screening.
+ PPD
+ CRx
Next step?
AFB smear
34
TB screening.
+ PPD
+ CRx
- AFB smear
Dx and next step?
Latent TB
INH + B6 x 9 months
35
TB screening.
+ PPD
+ CRx
+ AFB smear
Dx and next step?
Active TB
RIPE
36
Young patient with hemoptysis, night sweets, weight loss.
CRx with apical lesions
(+) AFB smear
Dx and next step?
Active TB
RIPE
37
Young patient with hemoptysis, night sweets, weight loss.
CRx with apical lesions
(-) AFB smear
Dx and tx?
Latent TB
INH + B6 x 9 months
38
Young patient with hemoptysis, night sweets, weight loss.
Normal CRx
(-) AFB smear
Next step?
Nucleic acid amplification test (NAAT) to rule out TB
39
Patient with suspicion of TB. culture is initially (-) but then comes back (+) after 6 weeks.
Dx?
Mycobacterium avium complex (MAC)
40
Side effects of Rifampicin
Red urine and hepatotoxicity
41
Side effects of INH
Neuropathy (B6 for prophylaxis) and hepatotoxicity
42
Side effects of Pyrazinamide
Hyperuricemia, gout and hepatotoxicity
43
Side effects of Ethambutol
Optic neuritis (Eye) and hepatotoxicity
44
Definition of sepsis
Severe organ dysfunction from dysregulated response to infection
Organ dysfunction is screen with qSOFA > 2 points
- RR > 22
- BP < 100 mmHg
- Altered mental status (GCS < 15)
45
Criteria of qSOFA?
Organ dysfunction in sepsis is screen with qSOFA > 2 points
- RR > 22
- BP < 100 mmHg
- Altered mental status (GCS < 15)
46
Definition of septic shock
Sepsis which is NOT responsive to IVFs presenting with:
- Persistent hypotension requiring vasopressors
- Serum lactate > 2 mmol/L
47
Definition of MODS (multiorgan dysfunction syndrome)
Septic shock + multiple organs failing
48
Goals of Early goal-directed therapy (management of sepsis)
```
Early -> Intervene within 6 hours
Goals
- Central venous pressure 10-12 mmHg
- Urinary output > 0.5 cc/kg/hr
- MAP > 65 mmHg
- Central venous saturation (ScvO2) > 70%
```
49
Management of sepsis
- IVFs (bolus of 30cc/kg)
- Empiric antibiotics (e.g., vanco + pip/tazo)
• Get cultures before
- Remove potential sources like drainage or plastics (e.g., central lines, endotracheal tubes, foley)
- Oxygen
- RBCs if Hb < 7
- Vasopressors if not responsive to IVFs
50
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Probable dx and Next step?
Meningitis
Next step: lumbar punction
51
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows 1000 PMN.
Dx and tx? What would be the tx if immunosuppressed?
Bacterial meningitis
Treat empirically with Ceftriaxone + vancomycin + steroids while the results of Cx come out.
If the patient were immunosuppressed, add ampicillin
52
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has rash that moves from arms to trunk. The patient was camping recently.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows no significant changes.
Dx and tx?
Rocky mountains spotty fever
Tx: Ceftriaxone
53
Patient with Fever, Headache, Photophobia, Phonophobia, arthralgias, Nausea and vomiting. On physical exam has a targetoid rash. The patient had a recent trip to Connecticut
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows no significant changes.
Dx and tx?
Lyme disease
Tx: Ceftriaxone
54
Patient AIDS with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting.
Dx, next step and tx?
Cryptococcal
Next step: cryptococcal antigen
Tx; Amphoericin
55
Patient (homeless/prisoner) with Fever, Headache, Photophobia, Phonophobia, night sweats, weight loss, hemoptisis Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows no significant changes.
Dx and tx?
Meningitis for TB
```
Tx:
Rifampicin
INH
Pyrazinamide
Ethambutol
```
56
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
Altered mental status, suspition of Immunosuppression, history of Seizures. Vitals: HTN, RR: 28, HR: 45.
Probable dx and Next step?
Meningitis
Next step:
- Empiric Abx (Ceftriaxone + vancomycin + steroids. If immunosuppressed, add ampicillin)
- Then, CT scan
57
Patient HIV (+) with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting.
Probable dx and Next step?
Toxoplasmosis
Next step:
Toxo Ab
Treat toxo and repeat scan in 6 weeks
58
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
Altered mental status, history of Seizures. Vitals: HTN, RR: 28, HR: 45.
Toxo Ab: Negative
Next step?
Biopsy to distinguis between cancer and abscess.
59
Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.
Lumbar punction shows ↑ lymphocites.
Dx, next step and tx?
Encephalitis
HSV PCR
Tx:
- If HSV PCR (+): IV acyclovir
- If HSV PCR (-): Supportive care
60
Patient with Red, hot, tender skin, Demarcated area with Site of entry. No abscess. Normal vitals.
Dx, microorganism and tx?
Cellulitis
Microorganism: Strep A (no abscess)
Tx: Cefalexin
Mark the edge of the infection and follow its evolution
61
Patient with Red, hot, tender skin, Demarcated area with Site of entry, abscess. Normal vitals.
Dx, microorganism and tx?
Cellulitis
Microorganism: Staph
Tx: Tmp-smx (PO)
Mark the edge of the infection and follow its evolution
62
Patient with Red, hot, tender skin, Demarcated area with Site of entry, abscess. The patient looks septic.
Dx, microorganism and tx?
Cellulitis
Microorganism: Staph
Tx: Vancomycin or Linezolid (IV) or Clindamycin
Mark the edge of the infection and follow its evolution
63
Patient with refractory celullitis. Dx?
Rule out Osteomyelitis
64
Patient Penetrating Wound with exposed bone. Dx and microorganism?
Osteomyelitis
S. Aureous, pseudomona
65
Patient with sickle cell with osteomyelitis. Microorganism?
S. Aureous, salmonella
66
Patient who was gardening and has Osteomyelitis. Microorganism?
S. Aureous, sporothrix
67
Patient with DM who has Osteomyelitis. Microorganism?
S. Aureous, pseudomona
68
Patient with cirrhosis who eats Oysters and has hematogenous Osteomyelitis. Microorganism?
S. Aureous, V. vulnificus
69
Patient with refractory celullitis. Next steps, tx and F/U?
Nest steps:
- 1st X-Ray
- 2nd MRI
- Best: Bx and Cx
Tx:
- Debridement
- 4-6 weeks of antibiotics
- Empirical: Vanco + pip/tazo
F/U: ESR, CRP. If they decrease, transition to PO
70
Patient penetrating wound contaminated with feces. On physical has Crepitus on skin. Dx, next step and tx?
Gas gangrene
Next step:
- X-Ray shows subcutaneous gas
Tx:
- Debridement
- Penicillin + Clinda
71
Patient with Refractory rapidly evolving cellulitis, Septic, Pain out of proportion, Crepitus, Blue/gray discoloration. Dx, next step and tx?
Necrotizing fasciitis
Next step:
- X-Ray showing gas
Tx:
- Surgical debridement
- 3rd gen cephalosporin + clinda + ampicillin
72
Who's called the Necrotizing fasciitis on the groin?
Fournier’s gangrene
73
Most common microorganism in Community-acquired pneumonia (CAP)?
S. Pneumo
74
Most common microorganism in CAP in COPD patient?
H. Influenza
75
Patient with pneumonia for aspiration. Mos common microorganism?
Klebsiella and anaerobes
76
Patient who had the flu and then has again cough, fever and consolidation. Microorganism?
S. Aureus
77
Most common microorganism in CAP in immunosupressed patient?
Legionella
78
Patient with fever, productive cough. CxR normal. Dx and tx?
Bronchitis
Tx:
Azithromycin or doxycycline or moxifloxacin
79
Patient with fever, productive cough. CxR with cavitatory lession. Next step?
CT scan to differentiate between Fungus, Cancer, TB and abscess.
If abscess --> ceftriaxone + clinda
80
Patient with fever, productive cough. CxR with consolidation. > 90 days from exposure to a “healthcare facility”
< 48 hrs from admission to a hospital
Dx and Tx?
Comminuty adquired PNA (CAP)
```
Tx:
3rd gen cephalosporin
+
Macrolide (Azithromycin)
OR
Moxifloxacin
```
81
Patient with fever, productive cough. CxR with consolidation. < 90 days from exposure to a “building”
> 48 hrs from admission to a hospital
Dx and Tx?
Healthcare associated PNA (HCAP)
Tx:
Pip/tazo or Cephepime
+
Vancomycin
82
Patient HIV/AIDS with slowly developing SOB and productive cough.
Dx, next step, and Tx?
Pneumocystis (PCP) PNA
Next step:
Silver stain of sputum
Tx:
TMP-SMX
+/-
Steroids (if hypoxemic)
83
How to define who needs to be admitted in PNA?
CURB-65 (if one is met, they are admitted)
- Confusion of new onset
- Urea > 7 / BUN > 19
- Respiratory rate > 30
- Blood pressure < 90/60
- > 65 years old
84
Tx of influenza?
Oseltamivir (Tamiflu)
85
Men with urethral dischrage. Dx, next step and tx?
Urethritis
Next step: Urinary GC/Chlamydia
Tx:
Ceftriaxone 250 mg IM, single dose
+
Azithromycin PO x 1 or doxycyclin PO x 7 days
F/U: HIV screening
86
```
Pregnant patient with.
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf
```
Dx and tx?
ASx bacteruria
Tx: amoxicillin; nitrofurantoin if PNC allergic
F/U: Repeat the screen
87
```
Asx patient, no risk factors.
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf
```
Next step?
Nothing
88
```
Patient with Urgency, frequency, dysuria. No risk factors.
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf
```
Dx, next step and tx?
Uncomplicated cystitis
Next step: nothing, no need for culture
```
Tx:
TMP-SMX x 3 days
or
Nitrofurantoin x 3 days
or
Fosfomicin x 3 days
```
89
Criteria for complicated cistitis
* Penis (men)
* Plastic (e.g., foley)
* Procedure
* Pyelonephritis
90
```
Men with Urgency, frequency, dysuria, and a foley catheter.
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf
```
Dx and tx?
Complicated cystitis
```
Tx:
TMP-SMX x 7 days
or
Nitrofurantoin x 7 days
or
Fosfomicin x 7 days
```
91
When to do a culture in UTI?
* Pregnant
* Procedure
* Pyelonephritis
* Multi-drug resistance
* Abx failure
Positive if > 105 colonies
92
Patient with Urgency, frequency, dysuria, Fever, chills. On physical exam has costo-vertebral angle (CVA) tenderness.
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf
Dx, next step and tx?
Pyelonephritis
Next step: Culture
Tx:
- IV Ceftriaxone or ampi-sulb if hospitalized x 10 days
- PO ciprofloxacin if ambulatory x 10 days
93
Patient with pyelonephritis who doesn’t improve after 72 hrs
Dx, next step and tx?
Perinephric abscess
Next step:
- CT scan if non-pregnant
- U/S if pregnant
Tx:
- Drainage
- Continue Abx for 14 days
94
Patient with singular, painless genital ulcer with nontender lymphadenopathy.
Dx, next step and tx?
Primary Syphilis
Next step: dark field microscopy
Tx: Penicillin x 1 IM
F/U
- HIV screening
95
Patient with fever targetoid rash involving palms and soles.
Dx, next step and tx?
Secondary Syphilis
Next step: RPR, if positive confirm with FTA-Abs
Tx: Penicillin x 1 IM
F/U
- Repeat RPR--> dilusions have to decrease after treatment
- HIV screening
96
Patient ASx, (+) RPR, Contraction < 1 year.
Dx and tx?
Early Latent Syphilis
Tx: Penicillin x 1 IM
F/U
- Repeat RPR--> delusions have to decrease after treatment
- HIV screening
97
Patient ASx, (+) RPR, Contraction > 1 year.
Dx and tx?
Late latent Syphilis
Tx: Penicillin q week x 3 weeks
F/U
- Repeat RPR--> delusions have to decrease after treatment
- HIV screening
98
Patient with Tabes dorsalis and Argyll-Roberston pupils (bilateral irregular small pupils that accommodate but don’t react to light)
Dx, next step and tx?
Tertiary Syphilis
Next step: Lumbar punction CSF-RPR, if positive confirm with CSF-FTA-Abs
Tx: Penicillin q4h IV x 10-14 days
F/U
- Repeat RPR--> delusions have to decrease after treatment
- HIV screening
99
Patient with Singular, painless gential ulcer with tender lymphadenopathy.
Dx, next step, tx?
Lymphogranuloma venereum
Next step: NAAT
Tx: Doxycycline
100
Patient with Singular, painful genital ulcer with tender lymphadenopathy.
Dx, next step, tx?
Chancroid
Next step: Gram stain + culture
Tx: Azithromycin or cipro
101
Patient with painful vesicles in genitals with erythematous base that tend to coalesce.
Dx, next step, tx?
Herpes
Next step: PCR
Tx: Acyclovir or valacyclovir
102
Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear.
Dx and next step?
Otitis media
Pneumatic insufflation
103
Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear.
On physical Pneumatic insufflation, the membrane doesn't move.
Dx and tx?
Otitis media
Tx:
- 1st: Amoxicillin
- 2nd: Amoxicillin-clavulanate
- Penicillin allergy: Cefdinir, azithromycin
104
Indications of tympanostomy
3 or more otitis in 6 months or 4 in a year
105
Patient with Unilateral ear pain, Worse by pulling the pinna.
Dx and tx?
Otitis externa
Tx:
- Spontaneous resolution
- Cipro drops
- Steroid drops
106
Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear, Swelling behind the ear, Anteriorly rotated ear.
Dx and tx?
Mastoiditis
Tx: Surgical decompression
107
Patient with more than 10 days of Congestion, Bilateral purulent discharge, Painful facial tap
Bacterial sinusitis
Amoxicillin-clavulanate
108
Patient with Sore throat, Odynophagia and fever. Cough (+), no exudates, no nodes.
Dx, and tx?
Pharingitis centor 1 (viral)
```
Centor criteria
• no Cough +1
• Exudate +1
• Nodes +1
• ****Temp +1****
• OR < 14 +1; > 44 -1
```
Tx: Centor >= 1--> viral, supportive tx
109
Patient with Sore throat, Odynophagia and fever. No cough, no exudates, no nodes.
Dx and next step?
Pharingitis centor 2
```
Centor criteria
• ****no Cough +1****
• Exudate +1
• Nodes +1
• ****Temp +1****
• OR < 14 +1; > 44 -1
```
Next step: Centor 2-3: Rapid strep (if positive get culture)
110
Patient with Sore throat, Odynophagia and fever. No cough, exudates, anterior nodes in neck.
Dx and next step?
Bacterial Pharingitis centor 4
```
Centor criteria
• ****no Cough +1****
• ***Exudate +1****
• ****Nodes +1****
• ****Temp +1****
• Age < 14 +1; > 44 -1
```
Next step: Centor > 4: Amoxicillin-clavulanate
111
Patietn with pharyngitis + enlarged spleen. Dx?
Mononucleosis
112
Baby that snores and has cyanosis when eating, pink when crying. Dx and tx?
Choanal atresia
Tx: Surgery
113
Duke criteria
Major
- Bacteremia (strep, staph, HACEK)
- New regurgitation murmur
- Vegetation on Echo
Minor
- Risk factors: PWID, history of endocarditis, prosthetic valves
- Fever
- Vascular complications (acute limb ischemia; Splinter hemorrhage; Janeway lesions)
- Rheumatologic complications: Roth spots; osler nodes, glmerulonephritis)
114
Splinter hemorrhage
hemorrhages underneath nails
115
Janeway lesions
non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles.
116
Roth spots
retinal hemorrhages
117
osler nodes
painful red, raised lesions found on the hands and feet
118
Patient PWID with CHF, Bacteremia and Toxic. Dx and next step?
Acute endocarditis
Next step:
- Blood cultures
- TEE
Tx: Treat until culture negative
119
Patient with Recurrent fever, with retinal hemorrhages and painful red, raised lesions found on the hands and feet.
Dx, next step and tx?
Subcute endocarditis
Next step:
- Blood cultures
- TEE
Tx:
Genta + ceftriaxone x 4-6 weeks. Start when cultures become positive
120
Antibiotics for infective endocarditis in native valve?
Vancomycin
121
Antibiotics for infective endocarditis in new prostetic valve of < 60 days?
Vancomycin + gentamycin + cefepime
122
Antibiotics for infective endocarditis in prostetic valve of 60-365 days?
Vancomycin + gentamycin
123
Antibiotics for infective endocarditis in old prostetic valve > 365 days?
Vancomycin + gentamycin + ceftriaxone
124
Patient with infective endocarditis who's allergic to vancomycin. How to replace vanco?
Daptomicin
125
Indications for surgery in infective endocarditis
- Vegetation > 15 mm
- Vegatation > 10 mm + embolization
- Abscess
- CHF
- Fungus
126
When to give prophylaxis for infective endocarditis?
[Congenital heart disease OR prostetic valve OR history of endocarditis]
AND
[Dental procedure OR bronchoscopy]
127
Antibiotic for prophylaxis for infective endocarditis?
Amoxicillin
128
Patient with infective endocarditis whose blood culture is positive for strep bovi. Next step?
Do colonoscopy. Patient highly suspicious of colon cancer
129
The three most common causes of fever of unknown origin (FUO).
Infection, cancer, and autoimmune disease.
130
Four signs and symptoms of streptococcal pharyngitis.
Fever, pharyngeal erythema, tonsillar exudate, lack of cough.
131
A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.
Postinfectious glomerulonephritis.
132
Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms—pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella.
133
The number of bacteria on a clean-catch specimen to
| diagnose a UTI.
105 bacteria/mL.
134
Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications.
135
A patient from California or Arizona presents with fever, malaise, cough, and night sweats.
Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B.
136
Nonpainful chancre.
1° syphilis.
137
A “blueberry muffin” rash is characteristic of what congenital infection?
Rubella.
138
Meningitis in neonates. Causes? Treatment?
Group B strep, E. coli, Listeria. Treat with gentamicin and
| ampicillin.
139
Meningitis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H. infl uenzae. Treat with cefotaxime and vancomycin.
140
What should always be done prior to LP?
Check for ↑ ICP; look for papilledema.
141
CSF findings:
| ■ Low glucose, PMN predominance
Bacterial meningitis
142
CSF findings:
| ■ Normal glucose, lymphocytic predominance
Aseptic (viral) meningitis
143
CSF findings:
| ■ Numerous RBCs in serial CSF samples
Subarachnoid hemorrhage (SAH)
144
CSF findings:
| ■ ↑ gamma globulins
Multiple Sclerosis
145
Initially presents with a pruritic papule with regional
lymphadenopathy; evolves into a black eschar after 7–10
days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.
146
Findings in 3° syphilis.
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms.
147
Characteristics of 2° Lyme disease.
Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis.
148
Cold agglutinins (a form of autoimmune hemolytic anemia in which cold agglutinins –agglutinating autoantibodies with an optimum temperature of 3 to 4°C–can cause clinical symptoms related to agglutination of red blood cells in cooler parts of the body and hemolytic anemia).
Associated with?
Mycoplasma.
149
A 24-year-old man presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension or fluconazol.
150
Begin Pneumocystis jiroveci (formerly P. carinii) pneumonia prophylaxis in an HIV-positive patient at what CD4 count?
Mycobacterium avium–intracellulare (MAI) prophylaxis?
≤ 200 for P. jiroveci (with TMP-SMX)
≤ 50–100 for MAI (with clarithromycin/azithromycin).
151
Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones.
152
Neutropenic nadir postchemotherapy.
7–10 days.
153
Erythema migrans.
Dx?
Lesion of 1° Lyme disease.
154
Classic physical findings for endocarditis.
Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots.
155
Aplastic crisis in sickle cell disease.
Microorganism?
Parvovirus B19.
156
Ring-enhancing brain lesion on CT with seizures.
Taenia solium (cysticercosis).
157
Name the organism:
| ■ Branching rods in oral infection
Actinomyces israelii
158
Name the organism:
| ■ Painful chancroid
Haemophilus ducreyi
159
Name the organism:
| ■ Dog or cat bite
Pasteurella multocida
160
Name the organism:
| ■ Gardener
Sporothrix schenckii
161
Name the organism:
| ■ Pregnant women with pets
Toxoplasma gondii
162
Name the organism:
| ■ Meningitis in adults
Neisseria meningitidis
163
Name the organism:
| ■ Meningitis in elderly
Streptococcus pneumoniae
164
Name the organism:
| ■ Alcoholic with pneumonia
Klebsiella
165
Name the organism:
| ■ “Currant jelly” sputum
Klebsiella
166
Name the organism:
| ■ Infection in burn victims
Pseudomonas
167
Name the organism:
| ■ Osteomyelitis from foot wound puncture
Pseudomonas
168
Name the organism:
| ■ Osteomyelitis in a sickle cell patient
Salmonella
169
A 55-year-old man who is a smoker and a heavy drinker
presents with a new cough and fl ulike symptoms. Gram
stain shows no organisms; silver stain of sputum shows
gram-negative rods. What is the diagnosis?
Legionella pneumonia.
170
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy.
What is the likely diagnosis, and how did he get it? Treatment?
Lyme disease, Ixodes tick, doxycycline.
171
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
