Clerkship - Infectious Disease

Front 1

Community aquired pneumonia (CAP) is usually which bacteria?

Nosocomial pneumonia is usually which bacteria?

Back 1

CAP = Strep Pneumoniae

Nosocomial = gram-negative rods and Staph Aureus

Front 2

pneumoniae in alcoholics

Back 2

klebsiella pneumoniae

Front 3

Legionella pneumoniae is common in which groups?

Back 3

organ transplant recipients, pts with renal failure, chronic lung disease, smokers

Front 4

Typical VS Atypical community aquired pneumoniae

SYMPTOMS

Back 4

Typical:
-Acute onset of fever and shaking chills
-Cough productive of thick, purulent sputum
-pleuritic chest pain (suggests pleural effusion)
-Dyspnea

Atypical:
-insidious onset: headache, sore throat, fatigue, myalgia
-Dry cough (no sputum production)
-fevers (chills are uncommon)
PULSE-TEMP dissociation (normal pulse in the setting of high fever)

both: rhonchi, crackles

Front 5

How do you Dx pneumoniae?

Back 5

PA and lateral Chest X-ray (CXR)

Front 6

If vital signs are normal, what is the probability of pneumoniae in outpatients?

Back 6

<1% If vital signs are normal

Front 7

A quick, cheap way to test for legionella pneumoniae?

Back 7

Urinary antigen assay
-however the antigen persists in urine for weeks, even after treatment has started
(there are other ways to test for it though)

Front 8

What is empyema?

Back 8

Empyema is caused by an infection that spreads from the lung and leads to an accumulation of pus in the pleural space. The infected fluid can build up to a quantity of a pint or more, which puts pressure on the lungs, causing shortness of breath and pain.

Front 9

Lung abscesses can be complications of ____, _____, ____, and _____

Back 9

1. Aspiration of organisms (especially oropharyngeal contents or food)
2. Acute necrotizing pneumoniae (gram-negative rods)
3. Hematogenous spread of infection from distant site
4. Direct inoculation with contiguous spread

Front 10

Main risk factor for Lung Abscesses

Back 10

predisposition to aspiration. This may be seen in pts with alcoholism, drug addiction, CVA (cerebrovascular accident), seizure disorders, general anesthesia, or a nasogastric or endotracheal tube)

Front 11

Lung Abscesses - The most likely part of the lungs to be infected by aspirated contents are?

Back 11

The dependent zones of the lungs: the posterior segments of the upper lobes and superior segrments of the lower lobes.

Aspirated material is most likely to affect the right lung because of the angle of the right main stem bronchus

Front 12

What is Ghon's complex? Ranke's complex?

Back 12

Radiographic findings in primary TB:

Ghons complex- calcified primary focus

Ranke's complex: calcified primary focus and calcified hilar lymph node

Front 13

Tx for TB

Back 13

four drug regimen: Streptomycin,INH,pyrazinamide,rifampin, ethambutol (SPIRE)

take this for 2 months followed by 4 months of INH and rifampin

Front 14

Tx for the flu

Back 14

largely supportive. Amantadine and Rimantadine decrease the duration of symptoms

Front 15

Cause of Acute Bacterial Meningitis in:

Neonates

Back 15

Group B strep > E Coli > Listeria monocytogenes

Front 16

Cause of Acute Bacterial Meningitis in:

Children (>3 months)

Back 16

Neisseria meningitidis > Strep pneumoniae > H influenza

Front 17

Cause of Acute Bacterial Meningitis in:

Adults (Age 18 - 50)

Back 17

Strep pneumoniae > N meningitidus > H influenza

Front 18

Cause of Acute Bacterial Meningitis in:

Elderly (>50)

Back 18

Strep pneumoniae > N meningitidis > L monocytogenes

Front 19

Cause of Acute Bacterial Meningitis in:

Immunocompromised

Back 19

L. monocytogenes > gram negative bacilli > Strep pneumoniae

Front 20

What are
Kernig's Sign and Brudzinski's sign

for Meningitis

Back 20

Kernig's sign: inability to fully extend knees when patient is supine with hips flexed

Brudzinski's sign - flexion of legs and thighs that is brought on by passive flexion of neck

Front 21

WBC count

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 21

Normal - <5
Bacterial Meningitis - >1000(1000-20000)
Aseptic Meningitis - <1000

Front 22

WBC differential

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 22

Normal - all lymphocytes or monocytes. No PMNs

Bacterial Meningitis - Mostly PMNs

Aseptic Meningitis - Mostly lymphocytes and monocytes

Front 23

Glucose

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 23

Normal - 50-75
Bacterial Meningitis - low
Aseptic Meningitis - normal

Front 24

Protein

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 24

Normal - <60
Bacterial Meningitis - high
Aseptic Meningitis - moderate elevation

Front 25

Diagnosis of meningitis - CSF should be sent for

Back 25

CSF should be sent for ccell count, chemistry (protein, glucose), Gram stain, culture (inc. AFB), and cryptococcal antigen or India ink

Front 26

WBC count

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 26

Normal - <5
Bacterial Meningitis - >1000(1000-20000)
Aseptic Meningitis - <1000

Front 27

WBC differential

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 27

Normal - all lymphocytes or monocytes. No PMNs

Bacterial Meningitis - Mostly PMNs

Aseptic Meningitis - Mostly lymphocytes and monocytes

Front 28

Glucose

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 28

Normal - 50-75
Bacterial Meningitis - low
Aseptic Meningitis - normal

Front 29

Protein

Normal
Bacterial Meningitis
Aseptic Meningitis

Back 29

Normal - <60
Bacterial Meningitis - high
Aseptic Meningitis - moderate elevation

Front 30

Diagnosis of meningitis - CSF should be sent for

Back 30

CSF should be sent for ccell count, chemistry (protein, glucose), Gram stain, culture (inc. AFB), and cryptococcal antigen or India ink

Front 31

Diff Dx in pts with FEVER & ALTERED MENTAL STATUS

Back 31

Infection: Sepsis, UTI/urosepsis, pneumonia, bacterial meningitis, intracranial abcess, subdural empyema

Medication: Neuroleptic malignant syndrome (haloperidol, phenothiazines), Delerium tremens

Metabolic: Thyroid storm

Front 32

What virus is associated with Cryoglobulinemia? What is cryoglobulinemia?

Back 32

Hepatitis C
ryoglobulins are single or mixed immunoglobulins that undergo reversible precipitation at low temperatures.

Front 33

Hepatitis E is particularly prevalent in which countries?

Back 33

India, pakistan, southeast asia, and parts of africa

Front 34

Symptoms of Acute Hepatitis:

Back 34

Jaundice (look at sclera)
Dark colored urine (conjugated hyperbilirubinemia)
RUQ pain
nausea and vomiting
Fever and malaise
Hepatomegaly