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44 Cards in this Set

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What percent of patients with pneumococcal PN present with positive blood cultures?
40%
What valve is commonly affected by pneumococcal endocarditis?
Aortic valve
How long is the duration of treatment for pneumococcal meningitis?
10-14 days
What is the preferred tx for pneumococcal meningitis?
Ceftriaxone and dexamethasone (vanco if PCN-resistant)
30 yo female with pneumococcal PN presents with new left-sided pleural effusion four days after beginning abx therapy. Is a thoracentesis appropriate to determine if the fluid is infected?
NO - if developed after initiation of abx therapy, fluid is usually sterile (don't want to infect it!)
In what two settings do staphylococcal pneumonias occur?
1. CAP: mostly as a complication influenza - occurs within a few days of initial onset of influenza
2. Nosocomial pneumonia - usually superinfection in immunocompromised patients
What symptoms may suggest a nosocomial PN?
Acute illness with fever, purulent sputum production, new infitrates, hypoxemia and leukocytosis
What conditions have known higher rates of staphylococcal colonization (cutaneous or nasopharyngeal)?
IV drug users, IDDM, hemodialysis, chronic dermatological conditions
Patients with pneumonia are at high risk of empyema formation if the pneumonia is caused by one of which two bacteria?
S. aureus and S. pneumoniae
What bacteria is associated with the highest mortality rate in nosocomial pneumonias?
Pseudomonas
What is the recommended empiric therapy for nosocomial pneumonias?
1. Aminoglycoside or FQ
2. Cefepime or Zosyn or imipenem or aztreonam/clindamycin
3. Zyvox
In an immunocompromised patient, defects in humoral immunity (antibodies) predispose the patient to __________ infections.
Bacterial
In an immunocompromised patient, defects in cell-mediated immunity predispose the patient to __________ infections.
Viruses, fungi, mycobacteria, and protozoa
The following factors make a patient more predisposed to pneumonia from...
1. Alcoholism
2. COPD
3. AIDS
4. Influenza/IV drug use
5. Hospital acquired
1. oral anaerobes, gram neg rods
2. S. pneumoniae, H. flu
3. Pneumocystis jerovici, TB, fungal
4. S. aureus
5. Gram neg rods, Pseudomonas, S. aureus
What number of CFU must be present to be a significant finding in a bronchial brush culture? In a bronch lavage?
Bronchial brush: 10^3 (1,000)
Bronchial lavage: 10^4 (10,000)
When are patients diagnosed with TB considered noninfectious?
After 3 negative sputum samples (usually after 4 weeks of treatment)
What is the gold standard for TB diagnosis in laboratory?
Auramine/Rhodamine immunofluorescent scan
All patient diagnosed with active TB should undergo what testing?
HIV
What is becoming the standard test for TB infection?
Quantiferon gold test (ELISA serology)
What four drugs should be used in the initial treatment of TB?
INH, rifampin, pyrazinamide, ethambutol
What drug for treatment of TB is contraindicated in pregnancy?
PZA
What drug is generally used for TB prophylaxis in exposed individuals?
INH
What bacteria commonly cause acute bacterial exacerbation of COPD?
H. flu, M. cat, S. pneumo, Chlamydia pneumoniae
What is the difference between a gallium and an indium scan?
Both are radiotracers that localize in areas of infection.
Gallium: leaks out of circulation where tissue is inflamed; good for soft tissue, occult infections, tumors
Indium: attaches to WBCs and localizes where they collect; good for acute infection, esp. in bone and joint infections
SIRS (systemic inflammatory response) criteria requires change in two of which categories?
1. body temperature
2. heart rate
3. respiratory function
4. peripheral leukocyte count
What is the difference between sepsis and septic shock?
Sepsis: SIRS plus documented infection

Septic shock: sepsis with hypotension, despite fluid resuscitation with evidence of inadequate tissue perfusion
Septic shock is most often caused by which organisms?
Gram neg
What three complications of septic shock have the biggest effect on mortality?
ARDS, DIC, ARF
Five steps of septic shock protocol
1. Antibiotics (within one hour of hypotension)
2. Norepi
3. Vasopressin
4. Low dose hydrocortisone
5. Mechanical vent
What bacteria is most commonly isolated from cat and dog bites?
Pasteurella multocida
Most common abx for dog/cat bites
Augmentin, clinda + cipro, diclox + PCN
What bacteria can be found in human bites?
Eikenella corrodans
What are the 2 main types of gas gangrene?
1. Traumatic: direct inoculation
2. Spontaneous: hematogenous spread (usually immunocompromised)
How is gas gangrene distinguished from necrotizing fasciitis?
Gross inspection of involved muscles at time of surgery
What is the treatment of choice for gas gangrene?
PCN + clindamycin
Causes of post-op fever ("W"s)
Wind - atelectasis
Water - UTI
Wound - Wound infection
Walking - DVT
Wonder drugs - Drugs
Presence of nitrates in U/A
Nitrates generally + in gram neg infections, and - in gram pos infections like enterococcus
How many squamous cells in a U/A indicate contamination?
> 5 squamous cells/HPF
Treatment for prostatitis
Bactrim; cipro/levo (can add alpha blocker to decrease urinary sx)
What are the three methods by which pyelonephritis can be acquired?
1. Ascending (bacteria travel up the urethra from outside contamination)
2. Hematogenous
3. Lymphatic (increased pressure on lymphatic connections between ureters and kidneys can cause lymphatic flow (w/ bacteria) to be directed toward the kidney
What organisms are most commonly responsible for causing pyelonephritis?
E. coli, S. saphrophyticus (also Proteus, Klebsiella, Enterobacter, Enterococcus)
What is likely to be found in a U/A of someone with pyelonephritis?
Bacturia, hematuria, pyuria, WBC casts, positive nitrates and LE
UTI is commonly defined as how many CFU/ml?
100,000
Empiric therapy for UTIs in patients with catheters
FQs and 3rd generation cephalosporins