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39 Cards in this Set

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Which of the following is not a criteria for health care associated pneumonia?
a. hospital in last 90 days for >48 hours
b. resident of NH or long term care facility
c. antibiotics in last 30 days
d. pneumonia in last 90 days
d. pneumonia in last 90 days
What are the 2 most common bacteria causing Health Care Associated Pneumonia?
a. Pseudomonas, H. influenza,
b. S. aureus, S. pneumoniae
c. Pseudomonas, S aureus
d. Legonella, Mycoplasma
e. Pseudomonas, S. pneumoniae
c. pseudomonas, s. aureus
What is appropriate treatment for Health Care Associated Pneumonia?
a. Ceftriaxone, Levofloxacin , Vancomycin
b. Cefepime, pipercillin/tazobactam, Vancomycin
c. Pipercillin/tazobactam, Levofloxacin
d. Cefepime, Amikacin
e. Cefepime, levofloxacin, Vancomycin
e. cefepime, levofloxacin, and vanco
A 45 year old male comes in to the ED after 12 hours of headache, neck pain, photophobia. On exam pt has meningeal signs. What is the appropriate antibiotic therapy.
A. Ceftriaxone 1g IV
B Ceftriaxone 2g IV and ampicillin 2g IV
C Chloramphenocol 1g IV
D Ceftriaxone 2g IV and Vancomycin 1-2g IV
E Ceftriaxone 2g IV, Vancomycin 1-2g IV and Ampicillin 2g IV
D. ceftriaxone 2gm IV and vanco 1-2gm IV
A 65 year old male comes in to the ED after 12 hours of headache, neck pain, photophobia. On exam pt has meningeal signs. What is the appropriate antibiotic therapy.
A. Ceftriaxone 1g IV
B Ceftriaxone 2g IV and ampicillin 2g IV
C Chloramphenocol 1g IV
D Ceftriaxone 2g IV and Vancomycin 1-2g IV
E Ceftriaxone 2g IV, Vancomycin 1-2g IV and Ampicillin 2g IV
e. ceftriaxone plus vanco plus ampicillin (to cover for listeria)
A 45 year old male with history of anaphactoid reaction to penicillin comes in to the ED after 12 hours of headache, neck pain, photophobia. On exam pt has meningeal signs. What is the appropriate antibiotic therapy.
A. Ceftriaxone 1g IV
B Ceftriaxone 2g IV and Ampicillin 2g IV
C Chloramphenocol 1g IV and Vancomycin 1-2g IV
D Ceftriaxone 2g IV and Vancomycin 1-2g IV
E Ceftriaxone 2g IV, Vancomycin 1-2g IV and Ampicillin 2g IV
c. chloramphenocol 1gm IV plus vanco 1-2 gm IV
A surgery resident was in the OR and had an incidental needle stick injury. The OR patient has unknown Hep B status. The residents has been vaccinated but did not have a titer drawn. What is appropriate therapy for the resident
A. Hep B vaccine
B. Hep B IG and vaccine
C. Wash wound and no therapy
D. Test resident for anti-HBs
d. test resident for anti-HBs
A surgery resident was in the OR and had an incidental needle stick injury. The OR patient is Hep B positive. The residents has been vaccinated but did not have a titer drawn. What is appropriate therapy for the resident
A. Hep B vaccine
B. Hep B IG and vaccine
C. Wash wound and no therapy
D. Test resident for anti-HBs
d. test resident for anti-HBs
A surgery resident was in the OR and had an incidental needle stick injury. The OR patient has unknown Hep B status. The residents has not been vaccinated. What is appropriate therapy for the resident
A. Hep B vaccine
B. Hep B IG and vaccine
C. Wash wound and no therapy
D. Test resident for anti-HBs
a. Hep B vaccine
A surgery resident was in the OR and had an incidental needle stick injury. The OR patient is Hep B positive. The residents has not been vaccinated. What is appropriate therapy for the resident
A. Hep B vaccine
B. Hep B IG and vaccine
C. Wash wound and no therapy
D. Test resident for anti-HBs
b. Hep B IG and vaccine
A 23 y/o male comes in with pain in his leg. He states it started as a small red area on his skin that is now warm and painful. On exam he has a 4 cm circular area erythematous, warm with no palpable fluid collection. By ultrasound he has multiple small fluid collections What is the best treatment
A. cephalexin
B. sulfamethoxazole and trimethoprim
C. dicloxacillin
D. ampicillin and clavulanic acid
b. sulfamethoxazole and trimethoprim
Cryptococcus neoformans. Note the prominent clear zone around the individual yeasts, consistent with the organism’s capsule. These yeasts are also in the process of budding.
What organism is depicted in this CSF stain?
The characteristic CSF analysis of a patient with cryptococcal meningitis
includes which of the following?
increase or decrease opening pressure?
Increase or decrease in WBCs?
Increase or decrease in CSF glucose concentration?
70% of AIDS pts have initial OP>200.
most have decrease in WBCs, mononuclear predominance.
Low CSF glucose concentration (<50mg/dL)
Where does infection begin in all patients with Cryptococcus?
Lungs, however, meningoencephalitis is the most frequently encountered manifestation
Cryptococcal meningitis rarely occurs in patients with a CD4 count greater than _____
100/mm3
What are the most common initial symptoms in a patient with cryptococcal meningitis?
Fever, malaise, headache (occurring over 1-2 weeks)
What are physical exam findings in a patient with cryptococcal meningitis?
Initial physical exam is often unimpressive
What is the percentage of acute mortality in patients with cryptococcal meningitis?
6-14%
Name the predictors of death during initial therapy in patients with cryptococcal meningitis.
abnormal mental status
CSF antigen titer > 1:1024
CSF WBC count < 20/mm3
diastolic hypertension (reflects hICP)
How is cryptococcal meningitis diagnosed?
Definitive diagnosis is with culture of the organism from the CSF
What are the three phases of treatment of cryptococcal meninigitis?
amphoB and flucytosine x 2-wk induction then
high-dose fluconazole (400mg/day) for 8-week consolidation phase
then
maintenance with fluconazole 200mg/day for long-term chronic suppression
What would be the appropriate antibiotic treatment for an otherwise healthy 30 year old male presenting with a warm, erythematous rash on his lower extremity? The rash is not fluctuant, there is no purulent drainage and he is afebrile.
a--Bactrim po
b--Keflex po
c--Doxycycline po
d--IV Zosyn
e--One dose IV Bactrim followed by po Bactrim
dpxycycline PO
A 60 yo diabetic male presents with a 3 day history of a small LE fluctuant mass with occasional purulent foul smelling drainage. He has had low grade fevers. What is the appropriate treatment?
a--I&D with culture and await culture results for appropriate antibiotic treatment
b--IV Unasyn and then po antibiotics once afebrile
c--I&D with culture and start Bactrim and Keflex while awaiting culture results
d--IV vancomycin without I&D
e--I&D with culture, pack with iodoform, topical antibiotics
c. I and D with culture and start bactrim and keflex while awaiting culture results
What are appropriate antibiotic choices for cMRSA skin infections?
bactrim, doxycycline, and clindamycin. if you are worried about strep species, as well, you are better off with doxy or clinda.
what is the most common bug causing UTI in young women, and what's number 2?
e coli, then staph saprophyticus. this is important, because they have different sensitivities. staph occurs in 20% of young women.
in the northeast, you are treating a child with new bell's palsy. what is the likely etiology?
lyme disease is a very common cause of bell's palsy in the northeast. other causes to be considered are herpes viruses.
a 5 month old child presents with wheezing and copious nasal secretions. you believe he has RSV. he is in no acute distress. you should
a. call his pediatrician, discharge him to followup in the morning
b. intubate him and put him in the unit
c. observe him for an hour or 2, then decide
d. admit him and observe him
d. admit him. there is a high risk for apnea in children with RSV who are less than 6 months of age. admit them all.
a man comes in complaining of rash. it is located on his wrists and between his fingers, and is very very itchy. he lives in a shelter. what is a likely diagnosis?
scabies. commonly involves webspaces, very itchy, and sometimes you'll see burrows. treat this with permethrin.
a patient comes in with itchy eyes. they are both injected with watery discharge. the patient is not a contact lens wearer. what do you do?
a. prescribe antibiotic drops
b. prescribe antibiotic ointment
c. give the patient bilateral eye shields
d. instruct the patient about careful hand washing
d. viral conjunctivitis and allergic conjunctivitis do not respond to antibiotics. so don't bother. just focus on keeping the patient from spreading the disease.
A 25 year old patient presents with 3 days of headache, fever, and neck pain. true or false: this time course of illness makes it unlikely the patient has bacterial meningitis.
false. 75% of bacterial meningitis presents after 1-7 days of symptoms.
which meningitides classically present with a chronic course and subtle findings?
tuberculosis and fungal (ie cryptococcus)
which cranial nerve is most commonly injured secondary to meningitis?
cranial nerve VIII
what is the role of steroids in meningitis?
steroids may decrease the risk of sensorineural hearing loss in children with h flu or s pneumo meningitis. it must be given prior to antibiotics, and is thought to blunt the inflammatory response leading to hearing loss and damage to CN VIII.
a patient has a fever and altered mental status. there is an infiltrate on cxr. are you done evaluating the patient for infectious processes?
you shouldn't be. up to 50% of patients with bacterial meningitis have an infiltrate on cxr. therefore, having pneumonia as a source doesn't mean the patient doesn't also have meningitis.
which bacterial meningitis carries the worst prognosis?
s. pneumo
what are the common etiological agents of meningitis in the new baby?
group b strep, e coli, listeria, and herpes.
you tap someone with meningitic signs. the tap was easy, but it was also bloody. does this change your management?
it should. up to 80% of patients with HSV encephalitis have bloody taps, so you should add acyclovir. you should also consider the possibility of a ruptured AVM, particularly in a kid, which can present this way.
what is the most common parasitic CNS infection?
neurocysticercosis
what is the most common cause of encephalitis?
HSV