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44 Cards in this Set
- Front
- Back
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What percent of patients with pneumococcal PN present with positive blood cultures?
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40%
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What valve is commonly affected by pneumococcal endocarditis?
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Aortic valve
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How long is the duration of treatment for pneumococcal meningitis?
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10-14 days
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What is the preferred tx for pneumococcal meningitis?
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Ceftriaxone and dexamethasone (vanco if PCN-resistant)
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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?
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NO - if developed after initiation of abx therapy, fluid is usually sterile (don't want to infect it!)
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In what two settings do staphylococcal pneumonias occur?
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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 |
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What symptoms may suggest a nosocomial PN?
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Acute illness with fever, purulent sputum production, new infitrates, hypoxemia and leukocytosis
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What conditions have known higher rates of staphylococcal colonization (cutaneous or nasopharyngeal)?
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IV drug users, IDDM, hemodialysis, chronic dermatological conditions
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Patients with pneumonia are at high risk of empyema formation if the pneumonia is caused by one of which two bacteria?
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S. aureus and S. pneumoniae
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What bacteria is associated with the highest mortality rate in nosocomial pneumonias?
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Pseudomonas
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What is the recommended empiric therapy for nosocomial pneumonias?
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1. Aminoglycoside or FQ
2. Cefepime or Zosyn or imipenem or aztreonam/clindamycin 3. Zyvox |
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In an immunocompromised patient, defects in humoral immunity (antibodies) predispose the patient to __________ infections.
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Bacterial
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In an immunocompromised patient, defects in cell-mediated immunity predispose the patient to __________ infections.
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Viruses, fungi, mycobacteria, and protozoa
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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 |
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What number of CFU must be present to be a significant finding in a bronchial brush culture? In a bronch lavage?
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Bronchial brush: 10^3 (1,000)
Bronchial lavage: 10^4 (10,000) |
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When are patients diagnosed with TB considered noninfectious?
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After 3 negative sputum samples (usually after 4 weeks of treatment)
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What is the gold standard for TB diagnosis in laboratory?
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Auramine/Rhodamine immunofluorescent scan
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All patient diagnosed with active TB should undergo what testing?
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HIV
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What is becoming the standard test for TB infection?
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Quantiferon gold test (ELISA serology)
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What four drugs should be used in the initial treatment of TB?
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INH, rifampin, pyrazinamide, ethambutol
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What drug for treatment of TB is contraindicated in pregnancy?
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PZA
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What drug is generally used for TB prophylaxis in exposed individuals?
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INH
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What bacteria commonly cause acute bacterial exacerbation of COPD?
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H. flu, M. cat, S. pneumo, Chlamydia pneumoniae
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What is the difference between a gallium and an indium scan?
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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 |
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SIRS (systemic inflammatory response) criteria requires change in two of which categories?
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1. body temperature
2. heart rate 3. respiratory function 4. peripheral leukocyte count |
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What is the difference between sepsis and septic shock?
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Sepsis: SIRS plus documented infection
Septic shock: sepsis with hypotension, despite fluid resuscitation with evidence of inadequate tissue perfusion |
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Septic shock is most often caused by which organisms?
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Gram neg
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What three complications of septic shock have the biggest effect on mortality?
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ARDS, DIC, ARF
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Five steps of septic shock protocol
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1. Antibiotics (within one hour of hypotension)
2. Norepi 3. Vasopressin 4. Low dose hydrocortisone 5. Mechanical vent |
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What bacteria is most commonly isolated from cat and dog bites?
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Pasteurella multocida
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Most common abx for dog/cat bites
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Augmentin, clinda + cipro, diclox + PCN
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What bacteria can be found in human bites?
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Eikenella corrodans
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What are the 2 main types of gas gangrene?
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1. Traumatic: direct inoculation
2. Spontaneous: hematogenous spread (usually immunocompromised) |
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How is gas gangrene distinguished from necrotizing fasciitis?
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Gross inspection of involved muscles at time of surgery
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What is the treatment of choice for gas gangrene?
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PCN + clindamycin
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Causes of post-op fever ("W"s)
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Wind - atelectasis
Water - UTI Wound - Wound infection Walking - DVT Wonder drugs - Drugs |
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Presence of nitrates in U/A
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Nitrates generally + in gram neg infections, and - in gram pos infections like enterococcus
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How many squamous cells in a U/A indicate contamination?
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> 5 squamous cells/HPF
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Treatment for prostatitis
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Bactrim; cipro/levo (can add alpha blocker to decrease urinary sx)
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What are the three methods by which pyelonephritis can be acquired?
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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 |
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What organisms are most commonly responsible for causing pyelonephritis?
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E. coli, S. saphrophyticus (also Proteus, Klebsiella, Enterobacter, Enterococcus)
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What is likely to be found in a U/A of someone with pyelonephritis?
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Bacturia, hematuria, pyuria, WBC casts, positive nitrates and LE
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UTI is commonly defined as how many CFU/ml?
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100,000
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Empiric therapy for UTIs in patients with catheters
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FQs and 3rd generation cephalosporins
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