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73 Cards in this Set

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Tx for gonorrhea
single dose:
Ceftriaxone (IM)
Azithromycin (po)
Cipro (po)
Coal tar is a treatment for what?
psoriasis - not an ID
4 criteria for SIRS
T <36 or >38, HR > 90, RR > 20 or pCO2 < 32, WBC >16 or <4
Sepsis vs Severe Sepsis vs Septic Shock
Sepsis is SIRS+bacteremia,
Severe Sepsis has hypotension, hypoperfusion, or organ dysfn,
Shock is unresponsive to fluid bolus
ICU stress test
ACTH (cosyntropin) should inc cortisol, if not the adrenals aren't working
Early treatment goals for sepsis (5)
1. w/in 6 hours 2. CVP 8-12 3. MAP >65 4. urine output > 0.5ml/kg/hr 5. Venous O2 sat > 70%
What drug has been shown to decrease mortality in severe sepsis?
Xigris (drotrecogin alpha) = activated Protein C
Predictor of progression to AIDS and mortality vs predictor of infection
1. viral load (<5000 = prolonged survival)
2. CD4 count
When to begin HAART?
When viral load is high (55k) or CD4 is low (<500)
Treatment for PCP when CD4 < 200
Septra
Treatment for Toxoplasma when CD4 <100
Septra
Treatment for +PPD at any CD4 count
INH + Pyridoxine (if active TB then use same 4 drug combo as usual)
What abx fro empiric bacteremia related to central catheter?
Vanco +/- cefepime or ceftazidime for pseudomonas coverage in elderly or immune compromised person
How long to treat an uncomplicated bacteremia?
14 days
How long to treat a complicated bacteremia (septic thrombosis, endocarditis, osteo, mets)?
6 weeks or more
What agents are ass'd with ventilator pna and how to treat?
Streptococcus, Pseudomonas, Enterobacter Klebsiella, Staph aureus (SPEKS of condensate in vent predisposes)-- Treat with b-lactam + aminoglycoside or antipseudomonal quinolone (cipro)
Infective endocarditis agents
Staph aureus, Strep viridens, enterococcus (after prosthetic valve, more likely coag neg staph (staph epidermidis))
endocarditis of tricuspid valve
IVDU
Phys Exam findings in endocarditis
1. new murmur
2. focal neuro
3. splenomegaly
4. petichiae
5. splinter hemorrhages
6. Osler nodes (violaceous painful lesions on fingers and toes)
7. Janeway lesions (painless, erythematous macular lesions on palms/toes)
Duke criteria for dx endocarditis
Major: 1. 2 + cx or 1 persistently + cx or Coxiella burnetti + cx; 2. Echo + for mass or valve dehiscdenece, or new regurg
Minor: 1. predisposed (IVDU) 2. Fever 3. Exam finding 4. multiple + blood cx 5. glomerulonephritis or Rh factor
Tx for endocarditis
Vanco + gent, for prosthetic valves add rifampin
TX for 4-6 weeks, then get echo to estab new baseline, and give ppx abx in future
Tx for latent TB infxn
INH x 9 months or rifampin x 4 mos
Tx for active TB
Typically lasts 6 months: for sure 2 months of 4 drugs: Rifampin, INH, pyrazinamide, ethambutol -- get sputum smear @ 2 month mark to determine rest of tx
When to call a TB expert for your active infxn pt
if no clinical improvement or still sputum + after 3 mos of tx
Who gets pneumococcal vax?
1. old 2. asplenics or immune compromised 3. Native Alaskans and Am Indians
When to hospitalize for CAP
HR >125, RR >30, BP < 90/60, T less than 96 or greater than 104
Out pt tx for healthy pt w/ CAP
macrolide (azithromycin or clarithromycin) -- doxycycline no longer en vogue
CAP tx for outpt with comorbidities (heart dz, lung, liver, etc)
Respiratory fluoroquinolone (levo, moxi) OR b-lactam + macrolide (cefuroxime, augmentin) -- non-ICU inpatients also get this tx except by IV
CAP tx for ICU pt
b-lactam + resp fluoro (could also do azithro, but less good) -- (b-lactams include ampicillin-sulbactam, ceftriaxone, or cefotaxime)
6 things that cover pseudomonas
1. Cefepime/Ceftazedime
2. Zosyn (pipercillin)
3. Imipenem/Meropenem
4. Aztreonam
5. Cipro (only oral option)
6. Aminoglycosides (gentamycin, tobramycin inhaled good for CF)
2 things that are good for MRSA
1. Vanco
2. Linezolid
Osteomyelitis tx
cover staph aureus: Nafcillin, cefazolin, or Vanco
UTI tx
1. Pyridium (urinary analgesic will turn urine orange: 200mg BID)
2. Septra BID for 3/7 days
3. Nitrofurantoin/macrobid BID x 7day
4. Cipro ($$)
5. can give Keflex sometimes __ Uncomplicated cystitis 3 days, anything else at least 7-10 days
What is nl urine pH?
4.5 - 8
What does alkaline urine mean?
Urease-producing infxn (proteus, pseudomonas) vs systemic alkalosis -- phosphate and Ca stones may develop
What does acidic urine mean?
high protein diet _vs_ systemic acidosis -- uric acid, cysteine, Ca oxalate stones may ppt
Specific gravity of urine
Nl = 1.003 - 1.030
low = diabetes insipidus, high = shock, dehydration, CHF, liver failure, nephritic sxme
Glucosuria (5 conditions)
DM, hyperthyroid, steroids, Cushings, shock
Proteinuria = renal dz when?
150 mg/day
hematuria
Renal dz, SLE, sickle cell, eclampsia, neoplasm, cirrhosis, infxn
Leukocyte casts in urine
diagnostic of pyelonephritis
4 kinds of tx for sinusitis
1. saline spray/irrigation 2. "mucolytics" and decongestants 3. intranasal steroinds dec inflmn 4. Abx - amox, augmentin, or bactrim or doxycyline for 10 days
CURB-65 criteria for admission for CAP
Confusion/disorientation, Uremia (BUN>20), RR >30, BP <90/60, age 65+
Gram + cocci in chains
Strep pneumo
Tell me about Legionella
PNA more common in transplant pt, renal failure, chronic lung dz, smokers -- Can do a urine test to check for antigen!
Gram + cocci abx for lung absess
ampicillin/augmentin, amp+sulbactam, or vanc
Anaerobe coverage
clindamycin, metronidazole
Gram - abx for lung absess
fluoroquinolone or ceftazidime
Tell me about influenza
Orthomyxovirus transmitted via resp droplets, amantadine, rimantadine to tx
Meningitis in neonates
listeria monocytogenes, GBS, e coli
Meningitis in adults vs elderly
Strep pneumo vs Neisseria vs H flu -- in elderly can be listeria monocytogenes -- immune compromised also get listeria or gram - bacilli
Aseptic meningitis agents
HSV, enterococcus
Meningitis + maculopapular rash, petichiae
Neisseria
Kernig sign vs Brudzinski
Kernig: can't extend knees, Brud = legs automatically flex when you flex the pt's neck
Cryptococcal meningitis
HIV, look for Ag or India Ink
Meningitis Tx
adults: ceftriaxone/cefotaxime + vanco
elderly: cef + vanco +ampicilin to cover listeria (this is also true for HIV, except cef needs to be ceftazidime/cefepime)
Tx options for cerebral edema
1. steroids
2. hyperventilation
3. mannitol (osmotic diuresis)
Brain abscess
Staph aureus (post-op) vs streptococcus (sinusitis) vs anaerobes from otitis media or lung abscess -- tx = PCN G + chloramphenicol or metronidazole for anaerobe coverage (naf or vanc if aureus suspected)
Hepatitis vaccine serology
Hep B Surface antigen
Hepatitis natural infection markers
core or HBe
Elevated LFTs (100s vs 1000s vs >10,000)
1. EtOH, chronic viral hep
2. acute viral hep
3. Necrosis: acetominophen tox, shock liver, +/-severe viral hep
Clinical hallmark of botulism
descending flaccid paralysis
Tx of botulism
can give antitoxoid
UTI w/ nitrites caused by what kind of bacteria?
gram -
Emphysematous pyelonephritis
gas-producing bacteria in DM
Numerous sheets of WBC in UA of young man could be what?
Acute prostatitis --> hospitalize for IV abx if toxic-looking, otherwise 4-6 weeks of septra or fluoroquinolone + doxy
Fitz-Hugh-Curtis Sxme
Chlamydia infxn with RUQ pain from ascending infxn --> inflmn of liver capsule
Toxoplasmosis in HIV
multiple contrast-enhancing lesions in BG and subcortical WM
Cryptococcal meningitis
Stain with India ink, tx with ampho B for 10-14 d, followed by oral fluconazole; bug is ass'd with pigeon droppings
Cellulitis tx
IV ceph or pen until signs of infxn improve, then po for 14 d
Cellulits agents (4 circumstances)
1. local trauma = group A strep (pyogenes)
2. wound/abscess = aureus
3. water = pseudomonas
4. acute sinusitis = h flu
clostridium tetani is what kind of bug?
gram + anaerobe bacillus--dz is from exotoxin
Tx for tetanus infxn
diazepam for tetany;
If 3 known vax doses: do not give anything;
If few doses or more than 10 yrs ago, give another vax for clean, minor wound, add tetanus immune globulin for nasty wound