Id Rotation - Exam Flashcards 3 (P. 127-177)

Front 1

Define infective endocarditis

Back 1

Disease that produces vegetations on the endocardium

Front 2

What are two essential features in the development of endocarditis?

Back 2

1. Bacteremia
2. Abnormality in the endothelial surface of a valve

Front 3

What are the two most common agents in native valve endocarditis?

Back 3

Strep viridans (more common) and Staph aureus (more common in IVDU)

Front 4

What agents commonly infect prosthetic valves?

Back 4

Staph, Gram neg organisms, and fungi

Front 5

Essentials of endocarditis diagnosis

Back 5

1. Pre-existing organic heart lesion
2. Fever
3. New or changed heart murmur
4. Evidence of systolic emboli
5. Positive blood culture

Front 6

What are the HACEK organisms?

Back 6

Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae

Front 7

T/F: HACEK organisms are the most common cause of culture-negative endocarditis.

Back 7

False, fastidious organisms (zoonotic agents and fungi) and strep species after antibiotics have been initiated are.

Front 8

What is the treatment for culture negative endocarditis?

Back 8

Ceftriaxone + gentamicin (+ vanco if prosthetic valves are involved)

Front 9

What are important complications of bacterial endocarditis?

Back 9

Valvular destruction (CHF, Cor pulmonale), perivalvular abscess, septic pulmonary emboli

Front 10

Endocarditis that occurs in patients with a history of GI manipulation, trauma, or systemic disease is often caused by:

Back 10

Enterococcus

Front 11

Treatment for Enterococcal endocarditis

Back 11

1. Ampicillin or PCN, gentamicin
2. Vancomycin or daptomycin if PCN resistant

Front 12

Treatment for S. aureus endocarditis

Back 12

Naficillin + gentamicin

Front 13

T/F: Esophageal perforation is the leading cause of mediastinitis.

Back 13

False; before cardiac surgery, esophageal perforation was the main cause - now mostly a post-surgical complication

Front 14

Treatment of prosthetic vascular graft infections

Back 14

Surgical therapy is almost always required - antibiotics alone are generally insufficient.

Front 15

What is the most common infecting organism in prosthetic vascular graft infections?

Back 15

S. aureus (also Enterobacteriaea and Pseudomonas)

Front 16

What bacteria are responsible for the majority of pacemaker site infections?

Back 16

S. aureus and coag negative staph

Front 17

How long is the duration of treatment for device associated endocarditis?

Back 17

6 weeks of IV abx (and complete removal of entire infected system)

Front 18

What bacteria causes rheumatic fever?

Back 18

Group A strep (S. pyogenes)

Front 19

What are anti-streptolysin O antibodies used for?

Back 19

To determine previous strep infection

Front 20

What are the most common pathogens in brain abscesses?

Back 20

Streptococci (also S. aureus, Bacteroides, Prevotella)

Front 21

What are the three most common settings that predispose a patient to brain abscess?

Back 21

1. Presence of a distant focus of infection with hematogenous spread
2. Contiguous focus of infection (45%) - ex: sinusitis, otitis
3. Cranial trauma or surgery

Front 22

What is the classic triad of symptoms for a brain abscess?

Back 22

Fever, headache, focal neurological deficit

Front 23

Fever + mental status changes =

Back 23

Spinal tap

Front 24

What is the dosing for dexamethasone in an adult?

Back 24

10mg q 6 hours

Front 25

What is the "serum formula" for traumatic taps?

Back 25

RBC/WBC in serum = 300-500:1

Front 26

T/F: Anything greater than 10 cells in the CSF is abnormal.

Back 26

False; 8 cells

Front 27

When a patient has recurrent meningitis, it is important to look for...

Back 27

HSV-2

Front 28

What 3 bacteria are responsible for 80% of bacterial meningitis cases?

Back 28

H. flu, N. meningitis and S. pneumo

Front 29

Empiric meningitis therapy

Back 29

Ampicillin, 3rd generation cephalosporin, vancomycin, dexamethasone

Front 30

What virus most commonly causes aseptic meningitis?

Back 30

Enterovirus

Front 31

Define encephalitis

Back 31

Inflammation of the brain with subsequent symptoms (ex: neurologic manifestations, coma, seizure)

Front 32

What are the 3 clinical stages of herpes zoster?

Back 32

1. Prodromal stage: pain and allodynia in the dermatomal region
2. Active stage: neuritic pain and pain in the involved skin as well as vesicles
3. Chronic stage: postherpetic neuralgias

Front 33

How soon must antiviral therapies be initiated for herpes zoster to avoid postherpetic neuralgias?

Back 33

Within the first 72 hours

Front 34

What is the preferred imaging for spinal epidural abscesses?

Back 34

MRI with gadolinium (CT with myelography adequate in most cases)

Front 35

What is the treatment of hidradenitis suppurativa?

Back 35

1. intralesional corticosteroids
2. surgery
3. oral abx
4. isoretinoin

Front 36

What are key characteristics of measles?

Back 36

Progression of rash downward from head and neck to trunk and extremities, Koplik spots, not on hands and feet

Front 37

What are key characteristics of Scarlet fever?

Back 37

Erythematous punctiform eruption that blanches, perioral pallor, prominent in neck, popliteal, axillary and inguinal areas, strawberry tongue

Front 38

What causes Fifth's disease (slapped cheek)?

Back 38

Parvovirus B-19

Front 39

What is the most common reason for admission in diabetics?

Back 39

Lower extremity ulcers/infections