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Infectious Disease

Infectious Disease

by adesa0019, Mar. 2013

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353 Cards in this Set

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	CNS infection aseptic meningitis #1 cause... if patient with C5-C9 terminal complement deficiency...	enterovirus at risk for recurrent meningitis with Neisseria meningitidimus
	CNS infection benign recurrent lymphocytic meningitis or Mollaret meningitis	HSV2
	CNS infection aseptic meningitis CSF labs and culture	negative
	CNS infection diagnose enteroviral meningitis or HSV	PCR
	CNS infection most common cause in US of bacterial meningitis	S pneumoniae
	CNS infection bacterial meningitis in neonates and elderly	Listeria monocytogenes
	CNS infection bacterial meningitis most common in neonates	Group B strep. Strep agalactiae
	CNS infection if meningitis is suspected, after LP start empiric ABx combo.... 1 other medication....	vanc and rocephin and dexamethasone. dexamethasone reduces release of bacterial toxins
	CNS infection meningitis cause if immunocompromised or have OM, sinusitis or pneumonia… if gram stain on CSF show gram positive diplococci then add this antibiotic to cefotaxime...	70% caused by S pneumoniae add vanc to cover pen resistant pneumococci
	CNS infection signs and symptoms of bacterial meningitis (4)	fever headache stiff neck signs of cerebral dysfunction
	CNS infection meningitis treatment 1. S. pneumoniea 2. N meningitidis 3. Listeria monocytogenes 4. Hib	1. vanc and 3rd gen cephalosporin 2. 3rd gen cephalosporin 3. amp or pen G 4. 3rd gen cephalosporin
	CNS infection diagnose possible brain abscess...	get sample either stereotactic aspiration or surgical excision. DO NOT LOOK FOR primary cancer with whole body CT scan
	CNS infection brain abscess treatment	1. IV antibiotics for 6-8wks 2. then prolonged oral antibiotics
	CNS infection cranial subdural empyema most common cause	paranasal sinusitis
	CNS infection cranial subdural empyema diagnosis and treatment	MRI craniotomy for better drainage
	CNS infection cranial subdural empyema signs and symptoms are slow or rapid	rapid
	CNS infection most common bacteria in spinal epidural abscess	S aureus
	CNS infection clinical presentation of spinal epidural abscess (4 stages)	1. backache and focal vertebral pain 2. then nerve root pain 3. spinal cord dysfunction 4. paraplegia
	CNS infection spinal epidural abscess diagnosis	MRI with gad
	CNS infection spinal epidural abscess treatment (3)	surgical decompression drainage IV abx
	CNS infection spinal epidural abscess empiric antibiotics (2)	vanc and 3rd gen cephalosporin
	CNS infection treatment for spinal epidural abscess with localized pain and radicular symptoms but NO long tract signs	abx alone but need serial neuro exams and MRI with gad to make sure abscess resolves
	CNS infection encephalitis defn	infection of brain parenchyma with associated neurologic dysfunction
	CNS infection 2 most common causes of encephalitis but nearly 50% cases are....	1. HSV and west nile 2. ?etiology
	CNS infection encephalitis symptoms (2)	AMS longer than 24hr and fever
	CNS infection encephalitis imaging	brain MRI to show location and extent of disease
	CNS infection encephalitis CSF and always test for and why?:	lymphocytic pleocytosis (increased WBC) HSV
	CNS infection 90% of adult cases of encephalitis are due to	HSV1
	CNS infection 2/3 of HSV encephalitis are due to	reactivation of latent HSV-1
	CNS infection HSV encephalitis sequelae and location	partial complex seizure due to infection temporal lobe
	CNS infection complication of HSV encephalitis	bilat temporal lobe hemorrhagic necrosis and death
	CNS infection HSV encephalitis CSF finding and imaging	lymphocytic pleocytosis temporal lobe inflammation (1 or both)
	CNS infection HSV encephalitis EEG	periodic lateralizing epileptiform discharges @ temporal lobes
	CNS infection HSV encephalitis diagnosis and treatment CAVEAT...	HSV PCR IV acyclovir because oral has poor penetration, so continue IV for length of treatment begin acyclovir without waiting for test results to reduce mortality
	CNS infection When to consider brain biopsy for encephalitis... West nile vector...	patients who do not respond to acyclovir Culex mosquito
	CNS infection West nile neuroinvasive disease clinical finding	focal weakness including flaccid paralysis
	CNS infection West nile neuroinvasive disease on CSF and diagnosis	lymphocyte pleocytocis with more neutrophils IgM antibiody
	CNS infection West nile virus infection treatment	supportive
	CNS infection prion disease 3 common features	RAPID progressive Dementia and myoclonus NORMAL CSF findings spongiform changes on autopsy
	CNS infection avoid this procedure if prion disease	invasive neurosurg because of contamination
	CNS infection sCJD - sporadic form finding in biopsy	PrPsc protein but this is usually after death
	CNS infection vCJD - variant presented with	psych presentation in younger patients with less rapid disease progress
	CNS infection pre-mortem diagnosis of vCJD	prion protein (PrPsc) in tonsillar tissue
	Skin and Soft Tissue 2 most common bacteria in skin infection... non-complicated cellulitis treatment: 2 options...	Group A beta-hemolytic strep S aureus keflex or dicloxacillin
	Skin and Soft Tissue lymphangitis and peau d'orange appearance of skin Which antibiotic will cover this and MRSA...	streptococcus clinda. bactrim and doxy get MRSA, but not beta hemolytic strep
	Skin and Soft Tissue abcess or drainage from existing wound	S aureus
	Skin and Soft Tissue superficial infection of upper dermis and SC fat and common cause.	eryspilas usually GABSH
	Skin and Soft Tissue necrotizing fasciitis is different from other skin infections	goes beyond SC fat to fascia and muscle
	Skin and Soft Tissue Type I necrotizing fasciitis	polymicrobial such as fournier gangrene
	Skin and Soft Tissue Type 2 necrotizing fasciitis	monobacteria such as Strep pyogenes or flesh eating bacteria
	Skin and Soft Tissue iron overload syndrome such as cirrhosis develop V vulnificus necrotizing fasciitis after (2)	1. raw or undercooked shellfish 2. trauma of skin then contaminate with sea water
	Skin and Soft Tissue Empiric antibiotics for necrotizing fasciitis due to GABHS or clostridia... PRECAUTIONS for GABHS....	include clindamycin 24hr contact precautions until 24hr abx complete.
	Skin and Soft Tissue Type 2 necrotizing fasciitis due to GABHS or clostridia myonecrosis include (2)	penicillin clindamycin
	Skin and Soft Tissue necrotizing fasciitis clinical	red lesions with significant pain and edema
	Skin and Soft Tissue Toxic shock syndrome is due to toxins released by (2)	staph strep
	Skin and Soft Tissue TSS is can occur with any ________, but mostly ________	beta hemolytic strep S. pyogenes
	Skin and Soft Tissue TSS treatment with clindamycin, why? This medication does NOT help with TSS...	inhibits toxin production and modulates tumor necrosis factor with staph or strep TSS.corticosteroids do not help.
	Skin and Soft Tissue dog bite vs cat bite	dog bite is less infectious
	Skin and Soft Tissue animal bite non medical treatment and vaccine questions	wound irrigation and debridement rabies and tetanus
	Skin and Soft Tissue animal bite on immunocompromised or hand/joint wound	prophylaxis with augmentin
	Skin and Soft Tissue pustule/papule/redness after days to weeks after CAT bite with tender LN that may drain. 1. bug 2. disease 3. treatment	1. Bartonella henselae gram neg. 2. cat scratch 3. self limiting but can give azithromycin.
	Skin and Soft Tissue human bite wound without evidence of infection should receive.... clenched fist injury (punch someone's mouth)...	augmentin for 3-5 days clinda and FQ or bactrim and flagyl to cover staph/strep and anaerobes
	Skin and Soft Tissue mild DM foot infections are caused by (2) and are treated with	staph and strep abx
	Skin and Soft Tissue DM foot ulcers that are clinically uninfected...	no abx
	Skin and Soft Tissue charcot foot and problem with DM foot infection	progressive deformity of wt bearing joint with deformity. also called neuropathic arthropathy. can mimic OM
	CAP most common pathogen... outpatient treatment (2) with no risk factors...	S. pneumoniae macrolide or doxy will handle above bacteria
	CAP outpatient treatment (3) with underlying comorbidities or drug resistant S. pneumo... pathogen with etoh	FQ or amox with macrolide or doxy K. pneumoniae
	CAP Treatment duration if discharged from hospital... pathogen in CF or structural lung disease	7 days P. aeruginosa
	CAP elderly present with this finding	tachypnea
	CAP When to order immediate thoracentesis with pneumonia (2)....	effusion occupying more than 50% of hemithorax on upright CXR or fluid level greater than 1cm on lateral decub
	CAP tests for ICU admission or severe CAP (4)	blood culture sputum stain and culture pneumococcal Ag legionella Ag
	CAP empiric antibiotics need to be started... vaccines given...	within 6hr of presentation. flu and pnuemovax
	CAP persistent fever after antibiotics (2 possibilities) Initial Treatment for CAP with cavitation....	drug fever or nosocomial infection vanc with rocephin and azithro. Concern for MRSA due to cavitation
	Tick-Borne Diseases lyme disease: bacteria... shape... vector...	Borrelia burgdorferi spirochete Ixodes deer tick
	Tick-Borne Diseases lyme disease early infection finding...	EM erythema migrans. target or bullseye at site of tick attachment pg. 26
	Tick-Borne Diseases Diagnosis of early lyme disease is based on..	clinical findings and EM, not serology
	Tick-Borne Diseases stages after early lyme disease is diagnosed by... LATE LYME cardiac complication and treatment...	ELISA myocarditis with heart block IV rocephin
	Tick-Borne Diseases If ELISA for lyme is positive or equivocal then...	western blot IgG and IgM antibody. Do not perform if Sx > 1mo because of false positive. Only test for less than 1mo. (Elevated IgM)
	Tick-Borne Diseases protozoa infection	Babesia microti or Babeesiosis
	Tick-Borne Diseases Babesiosis is similar to Lyme	same vector
	Tick-Borne Diseases B. microti reproduce inside .... and cause...	inside RBC, hemolytic anemia
	Tick Borne Diseases anemia found in Babesiosis (macro, micro, or normo)	macrocytic due to increased reticulocytes
	Tick Borne Diseases Babesiosis lab diagnosis (2)	PCR and intraerythrocyte ring
	Tick Borne Diseases Babesiosis treatment (2 different combos)	atovaquone and azithro quinine and clinda
	Tick Borne Diseases similar to early Lyme but different	STARLI - southern tick associated rash illness. Negative for B burgdorferi
	Tick Borne Diseases Signs and Symptoms of STARLI.... (4) treatment...	EM, fever, HA, myalgia doxycycline
	Tick Borne Diseases maculopapular rash	HME - human monocytic ehrlichiosis
	Tick Borne Diseases meningoenchephalitis (3) and CSF findings	HME RMSF Lyme lymphocytic pleocytosis
	Tick Borne Diseases 2 conditions with leukopenia (THEY ATTACK WBC)	HME - ehrlichiosis HGA human granulocytic anaplasmosis
	Tick Borne Diseases Ehrlichia chaffeensis attacks... Anaplasma phagocytophilum attacks...	monocytes neutrophils
	Tick Borne Diseases HME and HGA diagnosis	intraleukocytic clusters of bacteria (morulae) on buffy coat stain
	Tick Borne Diseases HME and HGA treatment and when	doxycycline and early or empiric
	Tick Borne Diseases HME and HGA symptoms	nonfocal fever, HS, myalgia and fatigue
	Tick Borne Diseases HME and HGA serology	may be negative in early infections but + 2-4wks later
	Tick Borne Diseases petechial rash what about CBC?	RMSF WBC is normal unlike HME and HGA
	Tick Borne Diseases RMSF empiric treatment... If pregnant...	doxycycline chloramphenicol
	UTI most common pathogen... First line treatment for uncomplicated in women... if allergic, then... (contraindication) if allergic to2nd choice, then... (contraindication)	E Coli bactrim nitrofurantoin (avoid if pyelonephritis suspected) fosfomycin (avoid if pyelonephritis suspected)
	UTI diagnosis	pyuria 10 or more WBC per microL of unspun urine clean catch
	UTI positive culture… T/F: obtain ROUTINE UA or culture from patient with urinary catheter…	10(5) or more CFU. False, do not obtain UA or culture
	UTI Dipstick.. Catheter patient with asymptomatic candiduria...	leukocyte esterase and nitrite indicates pyruia remove catheter. do not start antifungals.
	UTI uncomplicated UTI avoid....	urine culture because patient improves before urine culture is back
	UTI Acute cystitis in women uncomplicated treatment (3)	bactrim nitrofurantoin fosfomycin
	UTI symptoms of pyelonephritis include 2 major things... mild pyelo treatment... severe pyelo treatment...	symptoms of lower UTI flank pain that radiates to groin. mild: outpatient cipro severe: inpatient IV cipro
	UTI when to treat asymptomatic bacteruria (2)	pregnant women men/women undergoing invasive urologic procedures
	UTI men with symptoms of lower UTI usually have... treatment	acute prostatitis bactrim for 4-6wks
	Tb latent TB on chest xray	ghon complex - localized scarring of pulm parenchyma and LN
	Tb 10% of LTBI	develop active Tb
	Tb Tb in immunocompromised such as HIV... What do you do....	atypical Tb with extrapulm or disseminated disease start isoniazid and pyridoxine, assume patient has latent Tb. regardless of Tb test or IGRA
	Tb Mantoux TST test after 48-72hr.	check induration. negative if less than 10mm NOT REDNESS
	Tb BCG vaccination or BCG treatment for cancer or non compliant for follow up	check IGRA (interferon gamma release assay). comes from T cells response to Tb antigen
	Tb Booster effect	remote exposure to Tb can initially cause negative TST result than can become positive several weeks later. True Positive results
	Tb Active Tb tests	Tb skin test or IGRA CXR cultures and AFB. check culture even if AFB smear is negative
	Tb Tb diagnosis is suspected but not confirmed then perform	sputum NAA (nucleic acid amplification)
	Tb Tb suspicious but sputum studies negative, then… if suspected pleural Tb with negative pleural fluid studies...	bronch with lavage and biopsy. check pleural biopsy
	Tb treatment for LTBI (3)	9mo isoniazid or 4mo rifampin or 3mo once a wk rifapentine and isoniazid
	Tb Why give Vit B6 pyridoxine with isoniazid?	to prevent peripheral neuropathy
	Tb Active Tb treatment: initial phase (4).... continuation phase (2)... adjunctive medication if Tb meningitis or Tb pericarditis... DURATION of treatment for meningitis or pericarditis	initial 2mo isoniazid, rifampin, ehtambutol, pyrazinamide cont phase 4-7mo of isoniazid and rifampin steroids. 9-12mo
	Tb why is direct observed therapy preferred? If noncompliant with treatment for more than 2wks during initial 2mo phase....	noncompliance can result in transmission, drug resistance, and relapse. Restart from the beginning.
	Tb Multidrug resistant Tb is resistant to .... Which Tb drug is contraindicated in gout...	rifampin and isoniazid pyrazinamide can increase uric acid levels
	Tb BCG vaccine avoid in.... should be used with this population to prevent (2)	immunocompromised because live virus vaccine children for prevention of disseminated disease and Tb meningitis
	NTM most affected (2)	young adults and elderly
	NTM most common cause of NTM lung disease	MAC - mycobacterium avium complex
	NTM fibrocavitary disease similar to Tb in upper lobes of middle age men with tobacco history and chronic lung disease	MAC lung infection
	NTM nodular infiltrates in R middle lobe or lingula disease in middle age or elderly women who don't smoke....	MAC lung infection - Lady Windermere syndrome
	NTM What is next step for MAC, if typical woman has acid fast culture has + MAC.... MAC treatment combo (3)	repeat AFB sputum and culture because of risk of colonization. if 2nd +, start treatment. if negative do biopsy or bronch. macrolide, ethambutol, rifamycin
	NTM lung disease from water supply similar to Tb	M kansasii
	NTM M kansasii treatment (3) and duration	isoniazid, rifampin, ethambutol for 18mo
	NTM RGM - rapidly growing mycobacteria (3)	M fortuitum M chelonae M abscessus
	NTM RGM is caused by..	inoculation by dirty surgical items
	Fungal non neutropenic with candidemia remove… T/F: candida in blood culture is sometimes contaminant...	IV catheters F: never contaminant
	Fungal candidemia treatment if critically ill... Not critically ill… Candida in sputum of intubated patient… When to treat candida in urine...	echinocandin like caspofungin. flucon No treatment: candida pneumonia is RARE if neutropenic or undergoing invasive urologic procedure
	Fungal allergic bronchopulm aspergillosis is seen in (2)	Cystic fibrosis chronic asthma
	Fungal allergic bronchopulm aspergillosis acute treatment (2)	steroids and itraconzale
	Fungal invasive pulmonary aspergillosis treatment: CT scan finding...	voriconazole target lesion with necrotic center surrounded by ring of blood or halo sign
	Fungal black necrotic tissue of nose or palate	rhinocerebral mucormycosis (near fatal)
	Fungal mucormycosis treatment (2)	amphoteracin B and EMERGENT surgical debridement
	Fungal disseminated cryptococcus treatment induction (2) consolidation	amphoteracin B and flucytosine fluconazole consolidation
	Fungal Blastomycosis is found... Diagnosis and name of fungus... pneumonic...	OH and MS river valley, GREAT LAKES (leaves and wooded areas) Find broad based budding yeast forms on histopath. B. dermatitidis "cough and blasts"- pneumonia, ulcers and warts, may be disseminated to kidneys, liver, brain etc
	Fungal mild to moderate pulm blastomycosis treatment moderate to severe disease (_____ followed by _______)	1. itraconazole 2. ampho followed by intraconazole
	Fungal Histoplasmosis fungus is found... pneumonic...	H. capsulatum midwestern states of OH and MS river valley where bird and bat droppings are frequent in soil. "gives no history" often asymptomatic
	Fungal MILD histo disease MODERATE disease SEVERE disease	supportive treatment itraconazole amphoteracin
	Fungal Coccidioidomycosis is found..... After 1-3 wks presents with...	desert CAP and erythema nodosum. called Valley Fever
	Fungal Coccidiodomyocosis diagnosis	serology, also use for monitoring progress. cultures are not helpful
	Fungal Coccidiodomycosis uncomplicated treatment (3) and duration	ketoconazole fluconazole itraconazole for 3-6mo
	Fungal Coccidiodomycosis meningitis treatment duration	lifetime due to relapse possible if med DC'd
	Fungal ulcerative lesion after gardening that follow lymph channels and treatment	Sporothrix schenckii itraconazole
	STD purulent vag discharge, intermentrual bleeding after sex, dysuria, elevated pH. pelvic exam finding	cervicitis inflamed cervix, everything else looks fine
	STD rectal pain , tenesmus, rectal discharge	proctatis
	STD 2 most common causes of cervictitis and urethritis... Treatment...	C trachomatis N gonorrhoeae rocephin IM 250mg x 1 and oral azithro
	STD dysuria and penile discharge	urethritis
	STD most sensitive test for Chlamydia	endocervical or urethral swab for nucleic acid amplification (most sensitive)
	STD monoarticular septic arthritis DX: ?urine test...	N gonorrhoeae fluid culture Nucleic acid amplification urine test for N. gonorhhoease
	STD small number of necrotic vesicopustules on red base... Treatment...	DGI - disseminated gonococcus infection. N gonorrhoea IV rocephin 7-14days
	STD in patients with documented infection for chlamydia, all sex partners should be tested on this timeline… presumed chlamydia infection treatment...	60 days before the person exhibited symptoms. azithro or doxy
	STD high rate of co-infection	NG CT
	STD sexually active woman with abd/pelvic pain with cervical motion tenderness, uterine tenderness, or adnexal tenderness... Treatment...	PID IV cepaholosporin followed by 2 wks of oral doxy
	STD PID 2 most common causes	CT, NG
	STD unilateral pain and tenderness in epidiymis and testis with enlarged and tender spermatic cord	epididymitis
	STD N. gonorrhoea infection treatment (combo)	ceftriaxone 250mg IM x 1 and azithro or doxy. Rocephin covers GC, but azithro or doxy will cover chlamydia.
	STD genital and perianal ulcers: vesicular lesion on a erythematous base; sometimes patients will have pain and discomfort without ulcer. will present with fissure	HSV2
	STD less likely to shed virus... shed virus even if mild or subclinical disease...	1. HSV1 2. HSV2
	STD HSV diagnosis... Tzanck smear....	viral culture or PCR only helpful when results are +
	STD chancre or painless ulcer @ site of inoculation on mouth, external genitalia, perianal area, or anal canal	primary syphilis
	STD generalized rash non itchy on palms and soles. silver gray erosions with red border on mucosa (mucosal patches)	secondary syphilis
	STD neurologic, ocular, aortitis and gummas in any organ	tertiary syphilis
	STD syphilis treatment… if pregnant and pen allergic… acute febrile illness within 24hr of starting treatment for any stage of syphillis….	single dose of IM benzathine penicillin G. desensitize and treat with penicillin. Jarisch-Herxheimer rxn - NOT allergic rxn to pen.
	STD if had sex with syphilis patient within 3mo and serology is negative	treat anyway
	STD most frequent cause of genital ulcer except in US. cause...	chancroid H ducreyi
	STD tender red papules that become pustular and rupture to form painful ulcer. treatment (4 options)	chancroid azithro or rocephin or cipro or erythromycin
	STD after chancroid treatment	re-eval in 1wk to ensure improvement and correct diagnosis. could also be HSV or syphilis
	STD papule or ulcer that is painless and resolves without treatment. followed by PAINFUL unilateral inguinal LN, fever and malaise. LN may drain	LGV or lympogranuloma venereum
	STD LGV cause.. usually presents with	C trachomatis L1-3 proctitis or proctocolitis
	STD condylomata acuminata	genital warts
	STD genital warts caused by... linked to cervical ca... perinanal warts linked to...	1. HPV 6 and 11 2. HPV 16 and 18 3. anal ca
	STD flesh colored exophytic lesion that are hyperkeratotic and pedunculated	genital warts exophytic - outward projecting hyperkeratotic - thickening of outer layer of skin pedunculated -
	STD genital warts treatment and why? (2)	topical for symptomatic lesions or cosmetic reasons
	OM 1. most common bug 2. IVDA 3. sickle cell	1. S aureus 2. pseudomonas 3. salmonella
	OM draining sinus tract is seen in.... Treatment based on superficial wound or sinus tract culture results… If stable chronic OM, hold antibiotics until...	chronic OM correlates poorly with deep cultures from bone. they are limited value. So go with bone biopsy first before starting Abx. hold abx until deep bone culture obtained.
	OM Diagnosis imaging: 1st choice, 2nd choice... gold standard… T/F: normal ESR and CRP rule out OM...	MRI -if contraindicated like hardware, then CT scan. bone biopsy FALSE: normal ESR and CRP do not rule out OM
	OM DM2 foot ulcer that is likely present with contiguous OM	ulcer >2cm or present longer than 2 wks, or visible bone or positive probe to bone test
	OM DM2 foot ulcer - 1st step Antibiotics....	debride and culture before antibiotics. vanc and something that covers gram neg (meropenem)
	OM Duration of Abx for DM2 foot ulcer after surgery Duration of Abx for DM2 after resection surgery	6wks until wound heals
	OM infection of vertebral bodies and contiguous disc space is called... and is caused by...	spondylodiskitis bacteremia
	OM spondylodiskitis patients have 2 labs in 80% of cases. If blood cultures are negative...	elevated CRP and ESR CT guided biopsy
	OM symptoms of vertebral OM… T/F: surgery consult for uncomplicated hematogeneous vertebral OM….	progressive worsening back or neck pain over several wks and localized tenderness over spinal site of infection. surgery is not needed for uncomplicated.
	FUO definition	3wks of temp 38.3 or 101 or higher on several occasions with negative workup and hospital stay for 1wk
	FUO common infections that are labeled FUO (3)	Tb, endocarditis, abd/pelvic abscesses
	FUO fever free interval of at least 14days for patients with FUO (2) which can have intermittent rashes with fever?	herditary periodic fever syndromes such as Muckle Wells syndrome Mediterranean fever - can have rash
	FUO % of FUO without etiology despite extensive workup	50%
	Immuno most common primary immunodef	Selective IgA def
	Immuno poor or absent response to vaccination; frequent lung infections; autoimmune disorders, malabsorption, lymphoma	common variable immunodefiency. CVID
	Immuno patient with low serum immunoglobulin, how to confirm CVID?	poor antibody response to vaccine will confirm CVID
	Immuno test if suspecting complement pathway defect	CH50 or total hemolytic complement
	Immuno best way to prevent infections in complement def	vaccination
	Bioterror defn	intentional release of bacteria/toxin/virus for purpose of harming or killing civilians
	Bioterror worst class of agents	A
	Bioterror imaging of anthrax... Where is it found...	widened mediastinum on CXR or chest CT spores are found in soil. Inhale spores.
	Bioterror Inhaled anthrax prevention after exposure (2) cutaneous anthrax treatment… inhalation anthrax treatment...	60days of cipro or doxy cutaneous: oral cipro inhaled: IV cipro and 2 other antibiotics
	Bioterror smallpox other name	variola
	Bioterror small pox vs chicken pox	rash starts centrally then moves peripheral (small pox) and lesions are same stage of maturity
	Bioterror small pox rash starts...	buccal and pharyngeal mucosa
	Bioterror small pox treatment if exposed within 3 days	smallpox vaccine (live)
	Bioterror most dangerous form of anthrax and smallpox transmission	inhalation
	Bioterror Plague: bug and type and vector (2) and geography	gram neg coccobacillus Y. pestis flea bite from rodent or inhaled resp droplets from sick persion Southwest
	Bioterror plague diagnosis... Symptoms of bubonic plague... Which is more dangerous: bubonic plague or pneumonic plague...	safety pin shape of bipolar staining of sputum purulent lymphadenitis near innoculation site. bubo is swollen group of LN pneumonic plague is MORE dangerous
	Bioterror plague treatment (combo)	streptomycin and doxycycline
	Bioterror why is primary pneumonic plague considered terrorism	very rare
	Bioterror If asymptomatic and exposed to plague patient	doxy or FQ for 7 days
	Bioterror 1. most lethal biologic substance 2. bug type 3. mechanism	botulism gram positive bacillus prevents Ach release from neurons and flaccid. no muscle contraction
	Bioterror botulism Symptoms: classic triad	descending flaccid paralysis with bulbar signs normal temp normal mental status bulbar - impairment of function of the cranial nerves IX, X, XI and XII
	Bioterror bulbar signs (4) (pertaining to medulla oblaganta - lowest part of brain CN 9-12)	diplopia dysarthria dysphonia dysphagia
	Bioterror differential for botulism (2)	GB MG
	Bioterror botulism diagnosis and treatment	mouse bioassay from CDC equine derived trivalent antitoxin which does not reverse existing paralysis
	Bioterror abrupt onset of fever, chills, myalgia, anorexia	tularemia
	Bioterror serology for tularemia	difficult because it takes too long for Ab titer for rapid diagnosis
	Bioterror Tularemia - bug - transmission - treatment	gram neg coccobacillus tick bite or contaminated food streptomycin or gentamicin for 7-14 days
	Bioterror febrile prodrome, mylagia, prostration	VHF - viral hemorrhagic fever
	Bioterror shock and generalized bleeding	advanced VHF
	Travel Medicine malaria parasite	plasmodium
	Travel Medicine 48-72hr cycles of fever, HA, myalgia, N/V, belly pain, diarrhea	malaria
	Travel Medicine severe and lethal malaria (2)	P. falciparum - most common seen in US from returning visitors. P. knowlesi - not seen in Africa
	Travel Medicine Treatment for typhoid fever	3rd gen cephalosporin due to growing FQ resistance
	Travel Medicine If traveling to south east asia like India...	typhoid vaccine is LIVE vaccine
	Travel Medicine enteric fever, HA, cough, anorexia, hepatosplenomegaly, macular rash	typhoid fever
	Travel Medicine typhoid fever bug, transmission	Salmonella enterica human feces in water/food
	Travel Medicine typhoid carrier	typhoid baccili invade gallbladder especially if gallstones present
	Travel Medicine Avoid lomotil or loperamide with... If you are going to take for traveler diarrhea make sure you are also taking...	avoid antimotility in dyssentery or bloody diarrhea... antibiotic
	Travel Medicine flaviviridae and mosquito Aedes aegypti most likely caribbean, south/central america and asia	dengue fever
	Travel Medicine dengue fever symptoms... Called "Breakbone fever"...	fever, headache behind eyes, myalgia, and minor bleeding issues. Can have rash after fever breaks. PROMINENT LUMBOSACRAL PAIN
	Travel Medicine dengue fever treatment and vaccine	NONE
	Travel Medicine ingest contaminated food or water. if going to developing country...	HAV vaccine 1mo prior and booster 6-12mo after initial vaccine
	Travel Medicine fever, HA, malaise, rash after flee bite or body lice (2) and type usually seen (2) Treatment	Rickettsia typhi from flea Rickettsia prowazekii from lice are both gram neg war zone or natural disaster doxycycline
	Travel Medicine fever, myalgia, fatigue, HA, night sweat and later endocarditis and neuropsych symptoms after ingest contaminated milk and type	brucellosis - gram neg
	Travel Medicine brucellosis treatment (3)	doxycycline, rifampin or streptomycin/gentamicin
	Travel Medicine if HIV and traveling in southeast asia beware...	Penicillium marneffei (fungus)
	GI diarrhea lasting >7days	parasite or noninfectious
	GI stool culture after 3 things...	diarrhea >72hr with tenesmus, fever, bloody/mucus stools
	GI diarrhea after 6hr eating suggest______ due to 2 bugs	preformed toxin such as S aureus or B cereus
	GI diarrhea, fever, abd pain SEVERAL days after eating undercooked meat. with occasional blood and fecal WBC.... treatment... LATE COMPLICATION...	C. jejuni macrolide GBS
	GI dysentery or bloody/mucoid stools, tenesmus and high fever. It is spread...	Shigella oral fecal route
	GI shigella diagnosis and treatment	stool culture FQ for 5 days
	GI 72hr after eating undercooked meat or contaminated food or touching reptiles. Fever, abd pain +/- blood	salmonella
	GI Salmonella compared to other forms of invasive diarrhea	indistinguishable
	GI Salmonella dx: 5% complication with diagnosis OM is seen in...	stool culture aortitis - abd CT sickle cell
	GI healthy popn with salmonella diarrhea sick popn with salmonella diarhhea	supportive care FQ
	GI E. coli that causes hemorrhagic gastroenteritis... Type....	STEC - shiga toxin producing E coli O157:H7
	GI Diagnosis of STEC.. Treatment of STEC...	sorbitol MacConkey agar - cannot culture on routine media supportive - no antibiotics
	GI lead to hemolytic syndrome... dysentery with fever...	STEC EIEC - enteroinvasive E coli
	GI inflammatory diarrhea after eating chitterlings - pork intestines	Yersinia enterocolitis
	GI Y. enterocolitis may not cause diarrhea with bacteria localized to... and causing pain that mimics....	lymphoid tissues in peyer patches appendicitis
	GI N/V/diarrhea after eating contaminated seafood especially raw shellfish. main risk factor treatment (2 options)	Vibrio parahaemolyticus liver disease doxy or FQ
	GI poor prognostic sign of Cdiff... testing on formed stools... why repeat cdiff? T/F: no diarrhea rules out Cdiff...	pronounced peripheral leukocytosis no, if + then colonizaiton if ongoing symptoms with no alternative diagnosis. F: no diarrhea does NOT rule out cliff. severe disease can present with ileus
	GI Cdiff diagnosis... Initial treatment if mild symptoms... if fails initial treatment, but mild symptoms...	diarrhea with cytotoxin A and B flagyl repeat flagyl course
	GI 2 most common causes of viral gastroenteritis: n/v/diarrhea abrupt onset with 50% fever mostly kids treatment	norovirus and rotavirus norovirus - cruise ship rotavirus supportive care
	GI 2 most common parasitic GI bugs	Giardia lamblia Cryptosporidium parvum
	GI parasite that causes hemorrhagic colitis in travelers	amebiasis
	GI protozoa parasite in fresh water. diarrhea and wt loss, but no fever	Giardia
	GI Giardia test ______ stool samples due to..... treatment... short term sequelae after treatment	3 samples due to sporadic shedding flagyl lactose intolerance
	GI cryptosporidium and HIV cryptosporidium diagnosis general treatment treatment for severe infection (not HIV)	acalcuolous cholecystitis acid fast stain stool, not o and p. supportive nitazoxanide
	GI protozoa in contaminated food/water complication diagnosis	Entamoeba histolytica liver abscess stool antigen
	GI amebiasis treatment (two step) if symptomatic If asymptomatic	flagyl then paromomycin or iogoquinol to eradicate intestinal reservoir luminal amebicide only
	Transplant 3 drug regimen to prevent/treat infection in solid organ transplant	prednisone calcineurin inhibitor antimetabolite - mycophenolate mofetil
	Transplant why is HSCT (stem cell - bone marrow) different infection risk than solid organ tranplant?	profound neutropenia after HSCT. (bacterial and invasive fungal)
	Transplant most important viral infection that occurs after transplant... macrolides and azole antifungals will interact with (3) and cause...	CMV cyclosporine, tacrolimus, sirolimus. causing toxic levels
	Transplant bad sequelae of EBV after transplant	B lymphocyte poliferation to PTLD - post transplant lymphoproliferative disorder, so look for LN 5 mo after transplant
	Transplant most common fungal infection after lung transplant and during neutropenic phase after HSTC	Aspergillus
	Transplant protozoa that can reactivate after transplant causing CNS disease and cardiac disease after heart transplant. on brain scan see...	Toxoplasma gondii ring enhancing lesions
	Transplant who gets fluconazole s/p transplant?	liver transplant for Candida prophylaxis
	Transplant vaccine before or after transplant HSCT vs solid organ	solid organ before surgery HSCT revaccinate after immune system reconstitution.
	HAI defn and SINGLE most important measure to prevent HAI...	hospital acquired infection develop 48hr after hospitalization with no evidence infection was present or incubating at time of admission hand hygeine
	HAI most common type of HAI Diagnosis....	CAUTI urine culture >1000 CFU
	HAI catheterized patient with pyuria... antiseptic coated catheter as primary modality for preventing CAUTI...	not good indicator for UTI. NOT use as primary modality
	HAI most common bacteria for SSI (surgical site infection).... timeline defn for SSI...	S aureus within 30days of procedure
	HAI If cath tip culture is positive but no other signs of infection including negative peripheral blood cultures	not infection. colonization of cath tip
	HAI defn of HAP or hospital acquired pneumonia and VAP	48hr or more after admission and was not incubating at time of admission. 48-72hr after mechanical ventilation started
	HAI alternative diagnosis for HAP/VAP: fever, leukocytosis, purulent sputum, positive lower resp tract culture with NO new lung infiltrate	nosocomial tracheobronchitis
	HAI 4 treatment components of HAP/VAP MRSA in VAP and cannot tolerate vanc...	treat early administer empriic broad abx de-escalate abx when appropriate short duration therapy when feasible (8days) linezolid can be used for MRSA pneumonia and VRE
	HAI vanc resistant MRSA in blood stream invasive VRE (2)	daptomycin linezolid and daptomycin
	Endocarditis 3 bacteria that are worrisome.. normal TEE does not exclude endocartitis by this bacteria...	staphylococcus streptococcus enterococci S aureus can have normal TEE.
	Endocarditis prophylaxis antibiotics for (4)… What about MVP…. transient CNS bacteremia with central access...	1. prosthetic cardiac valve 2. previous episode of IE 3. congenital heart disease +/- repair 4. valvulopathy after cardiac transplant MVP or other low risk valve disease: no prophylaxis. transient CNS bacteremia does not require central access removal
	Endocarditis prophylaxis oral med and dose and timing... if allergic to first drug… T/F: prescribe oral antibiotics for infective endocarditis...	amoxicillin 2gm. 30-60 min before all DENTAL procedures or up to 2hr after procedure CLINDAMYCIN False: oral abc are not recommended for IE.
	HIV 90% of infected develop acute symptomatic illness within 2-4wks of infection range from simple fever to mononucleosis type syndrome. Labwork reveals....	acute retroviral syndrome. high viral levels. window period. high level of infectivity. HIV test negative, no seroconversion. HIV nucleic acid amplification tests positive.
	AIDs defn.. What ages to screen HIV?	CD4 below 200 or AIDs indicator opportunistic infection. age 13-64. can stop after 1 negative test if low risk.
	HIV 2 step diagnosis... monitoring disease (2)....	2 stage serology. First: HIV antibody (EIA) enzyme immunoassay 2nd: Western blot to confirm if EIA is positive monitor: CD4 count and viral load
	HIV important vaccines avoid these vaccines	pneumovax, hep B vaccine and annual flu live vaccines
	HIV need to exclude 2 active infections	1. MAC with negative cultures can lead to prophylaxis vs active treatment. prophylaxis does not treat active which could lead to resistance 2. Tb to determine prophylaxis vs active disease
	HIV cholesterol changes with HIV treatment.... best drug? insulin resistance and HIV	increase TG. total cholesterol, HDL and LDL lower. atorvastatin. insulin resistance worsens
	HIV heart disease and HIV	increased CV risk
	HIV few wks to months after ART, develop dramatic inflam response to opportunistic infection antigen - which ones? - treatment	IRIS - immune reconstitution inflamm syndrome Tb, MAC, fungal infections continue ART but add steroids to moderate inflammation
	AIDS defining illness related to thrush or HIV with oral/inhaled steroids... symptom... TREATMENT.....	esophageal candidiasis dysphagia flucon
	AIDS defining illness with HA and AMS diagnosis treatment monitor	cryptococcal meningitis (C. neoformans - fungus) antigen in serum of CSF ampho check intracranial pressure to avoid blindness
	AIDS defining illness of dry cough, SOB fever… diagnosis… treatment for mild vs severe… adjuvant treatment… if CD4>200 for 3mo...	P jirovecci pneumonia stain in sputum or BAL oral bactrim for mild PO2>70 IV bactrim for severe PO2<70 steroids can stop prophylaxis
	AIDS defining illness protozoa from cat feces causing encephalitis, fever JA, seizure... head CT/ brain MRI show.. treatment combo..	Toxoplasma gondii multiple ring enhancing lesions pyrimethamine and sulfadiazine
	AIDS Tb and AIDS. chest xray. drug change	extrapulm symptoms and ayptical CXR without cavitary lesions low dose rifabutin instead of rifampin
	AIDS most common location of CMV infection Before ART, most common CMV infection	GI tract retinitis
	AIDS kaposi sarcoma caused by is seen in...	HHV-8 gay men, not other HIV groups
	HIV when to start ART? (6)	AIDs illness symptomatic HIV CD4<500 HIV nephropathy active coinfection hepB or C pregnancy to avoid perinatal transmission
	HIV women should avoid this drug and why?	efavirenz a nonnucleoside RTI should not be given to pregnant or trying to get pregnant due to association with neural tube defect
	HIV initial HIV treatment for patient without viral drug resistance..	2 nucleoside analogue analogue reverse transcriptase inhibitors 1 nonnucleoside reverse transcriptase inhibitor combo pill once a day 3 or more drugs
	HIV if given protease inhibitor, then give	small dose of ritonavir to boost protease inhibitor drug level
	HIV When to perform resistance testing? When to test treatment failure? Sudden spike in viral load...	baseline and treatment failure when have suboptimal controlled viral loads while still receiving therapy due to false negatives. keep same regiment until results are in. sudden spike - not resistance, more likely noncompliance with therapy
	HIV what special group needs testing? T/F: stop ART in setting of IRIS… Immune reconstitution inflammatory syndrome	pregnant women False: do not stop ART if IRIS occurs
	HIV if pregnant and HIV, antiretroviral therapy can reduce HIV transmission to: preferred cocktail (4)	less than 2% zidovudine, lamivudine, lopinavir/ritonavir
	Viral infections which is worse Influenza A or B? Vaccine for pregnant...	A is worse killed virus vaccine or trivalent
	Viral infections influenza incubation most common complication if underlying chronic illnesses	1-4 days pneumonia
	Viral infections most common bacterias in secondary bacterial pneumonia from influenza pneumonia… Best treatment for acute onset influenza...	S aureus S pneumoniae H influenzae tamiflu (oseltamivir)
	Viral infections Who should get flu vaccine? When can you start antiviral treatment? Who should NOT get live vaccine?	every year if older than 6mo within first 2 days of symptoms if indicated do not give to immunocompromised or close contact with immunocompromised
	Viral infections HSV infection on skin or fingers #1 cause of blindness in industrial world and you see...	herpetic whitlow recurrent HSV-1 keratitis. dendritic ulcers by fluorescein staining
	Viral infections most common cause of sporadic encephalitis starts... and spreads causing LP reveals diagnosis	HSV temporal lobe and hemorrhagic necrosis pleocystosis with normal gulucose CSF PCR
	Viral infections mucocutaneous and visceral HSV infection treatment which also prevents reactivation in compromised host (3)	acyclovir valacyclovir famciclovir
	Viral infections HSV encephalitis or other serious HSV infection or cannot take oral... HSV in encephalitis... HSV in meningitis...	IV acyclovir encephalitis - HSV 1 meningitis - HSV 2
	Viral infections T/F: HSV-2 antibody test is useful for diagnosis... Avoid this med for HSV ocular infection...	False: only indicates previous infection topical steroids
	Viral infections VZV primary infection rash starts... VZV secondary infection	varicella or chicken pox face and extremities to the trunk zoster reactivation of prior infection
	Viral infection Varicella vaccine for... zoster vaccine for... VZV infection treatment	1st dose 12-15mo and 4-6yo 60yo or older acyclovir
	Antibiotics lipopeptide that kills gram positive aerobic including MRSA and VRE do not use for... side effect.	1. daptomycin 2. pneumonia - inactivation with surfactant 3. rhabo - check CK weekly
	Antibiotics glycolipopeptide that covers MRSA skin/soft tissue infection side effect	telavancin or vibativ nephrotoxic
	Antibiotics oxazolidinone bacteriostatic against MRSA and VRE best uses: (2) short term side effect long term side effect	linezolid Urinary and pneumonia myelosuppression especially plt - check weekly CBC mitochondrial toxicity
	Antibiotics 4th/5th generation cephalosporin that kills MRSA and enterobacteriaceae, but not pseudomonas or acinetobacter	1. ceftaroline
	Antibiotics carbapenem that is active against pseduomonas	doripenem
	Antibiotics glycylcycline bacteriostatic against MRSA and VRE but not pseudomonas do not use for (2)	tigecycline 1. bacteremia - poor penetration 2. UTI - poor penetration
	Antibiotics treats gram negative bacilli that are resistant to other abx like pan resistant Pseudomonas...	polymyxin or COLISTIN
	Antibiotics kills gram + and gram - bacteria including MRSA, VRE, and multidrug resistant gram negative especially cystitis	fosfomycin
	Antibiotics once daily for gram negative bacilli 2 side effects	aminogylcoside nephro and ototoxic
	Antibiotics treats MRSA and CNS due to indwelling foreign body in conjunction with other abx drug limitation avoid as monotherapy	rifamycin multiple drug-drug interactions rapid resistance
	Hyperbaric oxygen use for (3)	clostridial gangrene necrotizing fasciitis refractory OM
	Hyperbaric oxygen 2 contraindications	untreated PTX recent chemo with doxorubicin or cisplatin
	GI Initial: severe Cdiff treatment... Initial: severe Cdiff with shock or multiorgan failure...	vanc 150mg every 6h for 10-14 days vanc 500mg every 6h for 10-14 days AND IV flagyl 500mg every 8hr for 10-14 days
	GI 2nd recurrence of Cdiff	vanc taper over many wks
	OM prosthetic infection that patient refuses surgery... if MRSA, avoid this sole antibiotic...	lifelong antibiotics rifampin by itself can cause MRSA resistance
	Viral chicken pox exposure to HIV or immunosuppressed with unknown chicken pox history or ?vaccine history or pregnant woman	give varicella zoster immune globulin
	Antibiotics Which does not KILL bacteria in blood stream?	nitrofurantoin
	Myelitis acute onset of asymmetric flaccid paralysis with signs of infection. what test....	Ig M antibody for west nile virus
	HIV opportunistic infection when CD4 < 50	CMV
	Tick Borne Disease If you see erythema migrans, what do you do FIRST...	start doxy first. EMPIRIC TREATMENT
	CNS infection benign recurrent lymphocytic meningitis is caused by...	HSV 2 so check HSV PCR of CSF
	GI most common parasite that causes diarrhea in US... When to treat with flagyl...	blastocystis if diarrhea lasts more than 7 days, if not then conservative treatment
	ICU Treatment for intubated CAP with history of COPD on steroids with gram neg rods in sputum... Likely bacteria...	anti pseudomonas beta lactam with pneumococcal coverage plus AG plus azithro. You want 2 anti-Pseudomonas antibiotics
	HAI 3 ways to reduce VAP	1. keep head of bed elevated 30 degrees 2. chlorhexidine oral care 3. daily assessments to wean ventilator
	GI most common cause of traveler diarrhea... diagnosis...	ETEC - enterotoxigenic E. coli NOTHING. it is self-limiting
	HAI PREVENT SSI - medication protocol and clipping or shaving site before surgery?	antibiotic before incision and maintain therapeutic antibiotic levels during surgery until wound is closed. CLIPPING is preferred
	STD genital herpes treatment: primary infection... recurrent infection... suppressive therapy...	acyclovir acyclovir acyclovir
	CNS empiric ABx for meningitis that occurs after brain surgery (combo)... what about gentamicin?	vanc for MRSA and gram + meropenem for gram negatives poor CSF penetration
	GI/Travel Medicine prophylaxis for traveler's diarrhea if immunosuppressed or IBD or chronic cardiac disease...	rifaximin - nonabsorbed and sits in GI tract and attacks E coli
	UTI recurrent UTI in women: spermicidal cream... young woman who is sexually active...	spermicide will reduce lactobacilli which predispose to UTI. postcoital antibiotic for prophylaxis
	Shock LOW cardiac output: elevated PCWP (wedge pressure) and high SVR… low PCWP and high SVR (2)...	elevated PCWP and high SVR - cardiogenic shock low PCWP and high SVR - hypovolemic shock or obstructive shock like tamponade, PE, and tension pneumothorax
	Shock HIGH cardiac output: normal PCWP and low SVR (rash, stridor)… later CO drops and low SVR (fever and high WBC)...	normal PCWP - anaphylactic shock drop in cardiac output - septic shock
	Endocarditis HACEK organisms...	(Haemophilus parainfluenzae, Haemophilus aphrophilus, Haemophilus paraphrophilus), Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species. they were culture negative in past, but grow after 5 days
	Endocarditis What is concern for S bovid or C septicum related endocarditis...	eval for colon cancer
	EBV concern for hairy cell leukoplakia… if give ampicillin, you might get...	HIV morbilliform rash. NOT drug allergy. patient can still use amp in the future
	EBV T/F: antivirals are treatment for infectious mononucleosis...	FALSE: treatment is supportive care
	CAP edentulous patient does not get this type of pneumonia… Imaging with cavity + air fluid level vs no air fluid level… Should I select same class of antibiotics if recurrence of pneumonia within 3mo...	no teeth - No anaerobic pneumonia cavity with air fluid level - abscess from bacteria. cavity no air fluid level - Tb or fungal No, choose different class of antibiotic
	Tropical conjunctival suffusion after exposure to animal urine or dirty water/soil… (redness without exudates)	Leptopirosis
	Travel Medicine If a traveler returns from malaria area in past year and presents with undiagnosed febrile illness...	malaria evaluation

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