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Clin Med - ID > Lecture 3 - Cases > Flashcards

Lecture 3 - Cases Flashcards

1
Q

What causes pharyngitis and how do we treat it?

A

MC viral
Group A, C, H strep

Treat Group A strep (d/t risk of sequelae: scarlet fever, rhuematic fever)
PCN V x 10 days (or Amoxicillin if kids)
PCN allergy? Clinda or azithromycin

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2
Q

What is the treatment for group a strep in a young child?

A

Amoxicillin (PCN for everyone else, or clinda or azithro if PCN allergy)

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3
Q

What is the treatment for group a strep pharyngitis for those with a PCN allergy?

A

Clindamycin or azithromycin

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4
Q

What causes a UTI and how do we treat it?

A

Gram negative rods, enterococcus, staph, chlyamydia

Tx: nitrofurantoin
Bactrim or Quinolones (not in pregnancy)
Ceftriaxone PO

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5
Q

What causes OM and how do we treat it?

A

Viral: rhino, RSV, corona
Bacterial: strep pneumo, H. Flu, M. Cat

Tx: amoxicillin (<2yo always, older than 2 depends on some stuff)

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6
Q

What causes CAP and how do we treat it?

A 
Virus 
S. Pneumo (MC) 
Mycoplasma (MC atypical walking PNA) 
Chlamydia
H. Flu 
M. Cat 
Gram negative rods

For a healthy young adult the MC are: viral, mycoplasma chlamydia

Tx: macrolides (azithromycin - covers atypicals)

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7
Q

What causes meningitis and how do we treat it?

A 
Viruses
S. Peumo 
Neisseria m. 
H. Flu
Listeria (immunocompromised) 
Fungal: cryptococcus neofromans

CSF (Bacterial): low glucose, high protein

Tx: ceftraixone + vacno IV (+ ampicillin if listeria)

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8
Q

What is the MC cause of hospital acquired PNA and how do we treat it?

A

Staph aureus

Tx: cefepime + vanco

Cefepime (4th generation cephelosporin that covers MSSA and psuedomonas)

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9
Q

What is the tx for a post op wound infection?

A

Staph, strep, enterococcus

Tx: augmentin
Vanco is MRSA

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10
Q

When is PO vanco an appropriate treatment?

A

C. Diff only

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11
Q

What is the treatment for chlamydia and gonorrhea?

A

Chalmydia: 1 gram azithromycin (or doxy)

Gonorrhea: 250mg ceftriaxone + azithromycin

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12
Q

What is the treatment for chancroid? Syphilis?

A

Chancroid: ceftriazone (or azithromycin)

Syphilis: PCN G IM

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13
Q

What is the treatment for giardia?

A

Metronidazole

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14
Q

What are the different causes of acute vs chronic sinusitis and how do we treat?

A 
Acute Sinusitis: (same as OM)  
Viruses 
S. Penumo
H. Flu 
M. Cat

Tx: augmentin (+/- saline irrigation)
IF: sxs >/= 10 days, severe sxs for >3 days, or worse sxs post URI

Chronic:
Staph
Anaerobes
Fungal

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15
Q

What causes bronchitis and whats the treatment?

A

Viral MC

The longer the sxs the more likely its bacterial

Chlaymdia PNA, mycoplasm PNA, bordetella pertussis

Tx:
Antitussive
Inhaled bronchodilator

Doxycycline (if bacterial)

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16
Q

Whats the workup for a DM foot ulcer and how do we treat?

A

CBC, glucose, CMP, wound culture, Xray (r/o osteomyelitis)

Tx:
Anerobes: IV metronidazole or clindamycin
B. Fragillis: zosyn or unasyn

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17
Q

What are the GI parasties?

A

Giardia (beaver fever)
Amoebiasis (cysts, Entamoeba Histolytica, outside US)
Cryptosporidosis (modified acid fast)

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18
Q

What are the tissue parasites?

A 
Trypanosmiasis Cruzi (chagas - kissing bug - infection last YEARS) 
Trypanosmiasis Brucei (HAT - tsetse fly - G months - years) 
Leishmaniasis (sandfly - black fever - intracellular)
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19
Q

What are the blood parasites?

A 
Plasmodium 
Babesia (ixodes ticks - intraerythrocytic - ARDS complications - maltese cross)
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20
Q

What is the medication regimen for PrEP?

A

Tenofovir DF + emtracitabine PO daily

F/u q3 months for renal function tests

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21
Q

Owls Eye

A

Seen with CMV retinitis CD4 <50

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22
Q

Ring enhancing lesions

A

Seen on CT/MRI with toxoplasma gondii

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23
Q

What prophylaxis should be started at CD4 <75-50?

A

MAC with azithromycin 1200mg weekly

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24
Q

What is the drug regimen for PEP?

A

Raletgravir + tenofovir DF + emtracitabine

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25
Statins shouldnt be taken with which HIV drugs?
Protease inhibitors
26
Kaposis sarcoma
HSV 8
27
India Ink Stain
Crypotococcus neoformans Encapsulated fungus Chronic meningitis in HIV Lung infections
28
Who gets tuberculosis prophylaxis?
+ PPD Or anyone with contacts who have TB Isoniazid + B6
29
Polyradiuclopathy: ascending weakness —> flaccid paralysis
CMV CSF CMV PCR Tx: ganciclovir
30
Hemiparisis, cognitive impairment
PML - progressive multifocal leukoencephalopathy JC virus CNS infection Dx: LP JC virus PCR
31
Toxoplasmosis is seen at what CD4 level?
CD4 < 100 CNS occupying lesion seen as ring or contrast enhancing on CT/MRI
32
What are the pap smear guidelines for HIV pts?
Twice in the 1st year of dx Annually after that if no change in sxs
33
What is the most common cause of chronic diarrhea in HIV and how is it dx?
Cryptosporidum parvum Watery diarrhea Dx: modified acid fast Pretty sure this can lead to wasting (>10% loss of body mass)
34
How do you treat plasmodia ovale?
FIRST test for G6PD deficiency If no deficiency then start primaquine to kill the dormant parasites in the liver Then give chloroquine to treat the acute infection
35
How do p. Ovale and p. Vivax differ?
Both can lay dormant in the liver Vivax can cause splenic rupture Vivax needs duffy antigen to enter cells
36
Kopliks spot
Mouth sore seen with measles In addition to fever + URI Rash migrates from face toward the rest of the body Prevention: MMR (live) vaccine CI: pregnancy, egg allergy
37
Besides everybody over the age of 65, who else gets the pneumococcal vaccine?
``` Chronic heart, lung, liver dx EtOHism, smokers DM Immunodeficiency HIV Asplenia ```
38
If a pt who just got a prosthetic heart valve 30 days ago presents with fever, anemia, a new heart murmur, and a spot of her sole, what should you be thinking?
Endocarditis If <60 days since surgery MC cause is staph If >60 days since surgery MC cause is strep
39
What is the treatment for acute endocarditis?
Nafcillin + gentamicin x 4-6 weeks +/- surgery: - CHF - systemic embolization - uncontrolled sepsis - myocardia abscess - fungal infection - +/- large vegitation
40
What is the treatment for subacute endocarditis?
PCN + gentamicin
41
Who gets tested for HIV?
Everyone at least once between 15-64yo At risk populations Every pregnant pts
42
What classes of drugs are considered first line for HIV?
2 NRTIs + 1 integrase inhibitor
43
With which HIV drugs MUST you add a booster to?
Protesase inhibitors
44
What viral load is considered undetectable?
<20 cells Undetectable = untransmittable
45
You are awaiting HLAb5701 and HBV testing for a pt recently dx with HIV, what drugs should you star them on?
Dolutegravir + tenofovir/emtrictabine
46
When is the best time to start PEP?
Within 2 - 72 hours
47
You started a pt on PrEP, what do you tell the pt in regards to when they can start to have safe sex without worrying about HIV?
Women need to wait 3 weeks before meds are effective Men need to wait 1 week before meds are effective
48
When do you see a blanchable macuplopapular rash in HIV pts?
During 2-4 weeks after initial infection Primary infection
49
Diffuse intersitial infiltrates are seen with which pulmonary sequelae in HIV?
Pneumocysitis jiovecii
50
Severe decline in clinical status after ART initiation d/t inflammation response against infection (despite improved immune function)
IRIS
51
Which antibiotics inhibit protein synthesis?
MAT (50S, 30S, 30S) Macrolides Aminoglycosides Tetracyclines
52
What antibiotics kill MSSA?
DON Dicloxacillin Oxacillin Nafcillin methicillin isn’t used anymore
53
What antibiotic can be used for VRE?
Daptomycin Doesn’t work in lungs
54
What is the incubation of malaria?
1 week
55
ACTs
Artemisin based comibination therapies for p. Falciparum
56
When do you treat FUO with abx?
ONLY if they also have neutropenia
57
When dx endocarditis, is TTE or TEE more sensitive?
TEE Transesophageal echo (vs transthroacic)
58
What is the prophylaxis used for endocarditis pt?
Amoxicillin or cephalexin 2g PO
59
RIPE
Rifampin + INH + PZA + ethambutol For initial phase of TB Also give B6 (pyridoxine)
60
Rickettsia ricketssi
RMSF Triad: HA, fever, rash Rash starts on palms and sole and spreads centrally over 2-3 days 2-14 days after sxs being = onset
61
Borrelia burgdorferi
Lyme disease Same tick that causes babesiosis Dx: ELISA + western blot

Clin Med - ID (9 decks)

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