MKSAP-2 Flashcards
(31 cards)
Undulant fever-i.e. fever that has up-and-down pattern, Think this bug
Brucellosis
Intermittent fever with periods of remission lasting several weeks is common
Mode of transmission brucellosis
Ingestion of undercooked meat, raw milk, contaminated milk, direct contact with secretions and excretion of infected animals
In patients recently diagnosed with HIV, early initiation of antiretroviral therapy i.e. ART, early as and within 2 weeks has been shown to do this to patient’s___
Increased mortality at 30 days or 6 months
What happens with increased intracranial pressure coming from a cryptococcal meningitis as far as complications go
Sudden blindness, sudden deafness, coma
So do a lumbar puncture, may need frequent multiple lumbar punctures when they get headaches, Aggressive reduction of ICP reduces morbidity mortality!!
Brain abscess in immunocompetent patient etiology
Mastoiditis, sinusitis, otitis that is not treated
Recent neurosurgical procedure, cranial trauma
Most Commen, bacteria causing brain abscess
Streptococci, Staph aureus, Enterobacter, anaerobes
Wise bone biopsy so important for osteomyelitis workup?
Not only does it help with definitive diagnosis of osteomyelitis
Bone biopsy cultures are used for antibiotic therapyGuidance
Very first step to management for brain abscess
Aspirate the brain abscess, Gram stain culture
Latent TB treatment in immunocompetent patient
Short course of 3 months of isoniazid and rifampin
If cannot take rifampin, isoniazid monotherapy for 6 to 9 months
And viral meningitis, what is seen on Gram stain and culture of CSF?
Nothing, negative
What is a common bug for viral meningitis?
Herpes type II- Wintertime
Enterovirus-spring summer fall
How does HSV-1 versus HSV-2 affect CNS?
HSV 1 is more sporadic encephalitis, seizures, fever, altered mental status, focal deficits neurologically
HSV 2 more likely to have meningitis, do not even need acyclovir for therapy, has good outcomes
Comes with nuchal rigidity, fever, headache, photophobia
Immunocompromised patient comes in with oral a rind of cerebral necrotic lesion, consider this infection
Mucomycosis
Rhizopus Or mucus species
Have you diagnosed for viral meningitis like enterovirus or HSV from CSF study?
PCR, can rapidly diagnose
How does West Nile encephalitis present?
Diagnostic test?
Symmetric or asymmetric flaccid paralysis, kind of similar to polio
Diagnosed with IgM antibody in CSF
Best imaging test for detecting osteomyelitis
In this set setting that this test may not be performed, what the
, And the Neck step to that?
MRI with and without contrast
CT with IV contrast, neck step to that is tagged leukocyte scan or three-phase bone scan if CT is not an option
Patient with HIV with CD4 count less than 200 should be started on prophylaxis in addition to antiretroviral?
Prophylaxis with pneumocystis jiroveci with Bactrim
(Also helps protect against toxoplasma if the serology is positive)
-If the CD4 count >200 for at least 3 months, you can discontinue the Bactrim,
-If the CD4 count >100 but viral count has been suppressed for 3 months, can discontinue Bactrim
Risk factor for mucomycosis
Uncontrolled diabetes
Treatment for mucomycosis
Amphotericin B
A complication of mucomycosis
How?
Cranial nerve palsy, Like 7th cranial nerve
Spread from rhino cerebral necrosis at the sphenoid sinus to the adjacent cavernous sinus or carotid artery involvement, can also cause sinus thrombosis
What is an appropriate time to involve MRI with without contrast for osteomyelitis evaluation?
When plain radiograph is unrevealing
However if the plain radiograph is quite specific for bone infection i.e. stating there is cortical destruction, periosteal reaction,Then do not order MRI!!!
Need bone biopsy instead!!!
Antibiotics regimen for pelvic inflammatory disease
Cefotetan/cefoxitin + Doxy
OR
Rocephin + Doxy + Flagyl
14day
Is a herpes screening routinely done in asymptomatic patients?
No
When screening a patient for STDs
HIV, syphilis, GC chlamydia
4 Ds of botulinum
Diplopia
Dysarthria
Dysphagia
Dysphonia
