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154 Cards in this Set

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What vaccines should not be given to HIV patients?

live vaccines like MMR and vZV can only be given if the CD4 count is >200

Should you continue prophylaxis for a nurse who got stuck by needle of pt whose status of HIV is unknown?

yes give her prophylaxis anyway until result of test is back or for 4 weeks

Can a kid with HIV positive go to school whether on treatment or not?

yes, he can, he doesn't have to tell anyone at school about it

What are the viruses that cause meningitis in kids?

arbo viruses and enteroviruses



stl encephalitis west nile virus



california encephalitis colorado tick fever

What are the most common viruses that cause meningitis in adults?

HSV


in immunocompromised you see CMV and adenoviruses

What is the most initial test for HIV, and who gets it?

HIV p24 antigen and antibody screen (not RNA)



ppl getting TB or other STD treatment



ppl in werid sex relationships or more than 1 partner since last visit



ppl exposed to jail or homelessness, ppl exposed to others body fluids

What is prognosis of child with otitis media?

they will get frequent episodes

How to treat C. Diff? recurrence?

first episode = 1 week metronidazole



2nd episode= 1-3 weeks near first one 10-14 days metronidazole



3rd episode PO vancomycin 6 weeks



last option is fidaxomicin or fecal transplant




if at any point pt has leukocytosis >15 or creatinine >1.5 you gotta treat with PO vancomycin

When is colonoscopy used in C. Diff suspicision?

when stool studies are negative and c. diff still high on differential pts get a colonoscopy

What if you have myalgias rash on face and trunk and extremities, have a headache lymphadenopathy fever + leukoplakia and thrombocytopenia? what tests are positive?

the initial presentation of HIV



HIV ELISA maybe negative for 10-21 days.



What are the types of sensitivity reactions?

Type 1 is IgE , Type 3 is igG


Type 2 is Ig mediated cell death, Type 4 is T cell mediated cell death


Type 5 is autoimmune antibodies



Type 1 fast allergic response by IgE and mast cells(asthma)



Type 2 Cytotoxic antibody dependent -- antibodies attach to cells and destroy them


(autoimmune hemolytic anemia)



Type 3 IgG's create lots of circulating immunoglobulins ( serum sickness, RA)



Type 4 Th1 cells activated on first round of exposure--> second round you get lots of cells death due to Th1 killing you.


(contact dermatitis, and chornic transplant rejection, multiple sclerosis)



Type 5 Autoimmune auto antibodies (graves , myasthenia)

What is important about corneybacterium infection initial treatment?

if suspicion is high give diptheria antitoxin immediately

What are the side affects of diptheria antitoxin?

made from horse serum so you get anaphylaxis,


serum sickness or hypersensitivity






What is treatment for serum sickness treatment?

epinephrine

What complications of diptheria infection if you don't treat it?

you can get neurotoxicity



erythema multiforme


hepatotoxicity



bleeding complications

What is the prophylaxis for N. Meningiditis relatives who have had exposure to resp or salivary secretions?(not to ppl who hang around in the same room)



when to give it?

rifampin 60mg BID for 2 days




or ciprofloxacin 500mg single dose



or cefrtriaxone single dose



(pregnant ladies on ocp's cannot take rifampin)

What are treatment options for PCP PNA?

IV bactrim + prednisone




if cannot tolerate, then IV pentamidine



else IV trimetrexate

If UTI symptoms and pt urine shows dischagre thats wattery what to do?

wattery dischagre that is less purulent= chlamydia



so you treat with azithromycin

What is alteranative treatment to chlamydia?

first line is azithromycin



second line is doxycycline

What is dosing for treatment for N. gonorrhea?

ceftriaxone 250mg once IM

What is the treatment for C. trachomatis?

doxycycline 100mg BID X 7 days



or



1q azithromycin single dose

When do you treat for bacterial enterocolitis?

when <1 yrs old



immunocompromised




adult >50 with CAD can get heart bacteremia

HIV on TPN gets loss of vision, what is this?

candida opthalmitis

What are candida endopthalmitis lesions described as?

large, glistening, off white lesions with indistinct borders seen

What is treatment in candida endopthalmitis?

you will treat this with vitrectomy



and



amphotereciin B

What if HIV patient has esophagitis?---> EGD showing large ulcers --> no viruses on culture?

just apthous ulcers

How to treat apthous ulcers?

prednisone

What is the typical presentation of budd chiari syndrome

you see ascites and sevee abdominal pain



in happens in middle aged women

Who gets hepatitis B treatment?

you get it if you have severly impaired liver synthetic fxn on presentation

Who gets chronic liver disease in Hep B patients?

neonate infection = 90% chance of liver disease




adult Hep B= 5% chance of liver disease

Hep C patients, how much of them get liver disease?

50% of them go to chronic liver disease

What is active TB treatment for pt that is pregnant?

Rifampin Isonizaid and Ethambutol X 9 months




if multidrug resistant TB then do RIPE X 9 months

HIV patient with rapidly declining mental status and having lots of decreased movement problems?

progressive multifocal leukoencephalopathy



What causes PML?

jc virus, polyoma virus of the papova viridae

What does brain biopsy of PML look like?

oligodendrocytes with intrnuclear inclusions, demyelination and astrogliosis

What is the treament for PML? what is their progrnosis?

HAART---> improves patients over two years



only if CD4 >100 and viral load <500




else ppl die in 6 months


What are common causes of UTI's in kids?

constipation causing incomplete bladder emptying



poor wiping hygiene

Where is RMSF seen?

central/southeastern states

What is typical of RMSF other than rash?

fever myalgias headache



focal neurological signs



seizures



multiorgan dyzfxn

Do you wait for cultures to be positive once you see RMSF clinically?

no just start treatment

What is treatment for RMSF?

doxycycline



chloramphenicol if pregnant

hiker gets insect bite--->papule getting larger---> ulcerates and weeps clear drainage?

this is sporotrichosis

What is treatment for sporotrichosis?

itraconazole 3-6 months

What is the presentation of actinomycetes infection?

ppl with dental probs get it from other ppl



you see thick yellow dischagre and multiple abscesses



and swollen lymph nodes

What is the difference between blasto and coccidiomycoses?

both show up as PNA



cocci shows up as delayed hypersensitivty Type 4 rxn as erythema nodosum on pretibial area



blasto can spread to skin bones and GU system.

What is the best initial diagnositc test for lyme disease?


what about cinfirmatory test?

enzyme linked immunoabsorbent assay




next best is the western blot to confirm

What is the treatment for lyme disease?

doxycycline X1 month



or



amoxicillin if <8 yrs old or prengnant

How many months does lyme disease take to recover from?

6- 12 months

what is the timeline of symptoms of lyme disease?

first month= rash erythema migrans



2nd month to weeks you get myalgias and arthralgias + CN 7 defecits and meningitis/ encephalitis if you get in this period



years later you are left with neuropathy and arthritis if left untreated

Where do you see borelia borgdefori?

in the north east



in the upper midwest



seen in the deer tick aka Ixodes

What are the diagnostic tests that should be done for PCP PNA?

if sputum negative



--> "do bronchial washing and biospy



do not start treatment without diagnosis"

When to start steriods for pcp treatment?

PaO2 <70


on room air



A-a gradient 35 or more indicate moderate severe pcp infection




so you should start steroids

If you are asymptomatic but UA shows pyuria + bacteria who do you still treatment?

pregnant women



ppl getting urology procedure



ppl getting hiparthroplasty


What is classic presentation of rubella?

aka german measles



you see in kids rash starting at head going to toes



erythematous maculopapular rash



lymphadenopathy



for



schchimer spots (patchy erythema on soft palate)



in adults you see all that have myalgias arthralgias

What does a neonate with congential rubella look like?

sensorineuoral hearing loss



patent ductus arteriosus



cataracts + glaucoma



hydrocephalus



mom in first trimester when she gets this infection

What is the diagnostic tests for rubella?

pcr



testing IgM, IgG

What is treatment for rubella?

supportive care

What is the difference between rubella and rubeola?

cough coryza, conjuntivits, koplik spots for rubeloa(aka 9 day measle)



both have rashes from head to toe



What is roseola presentation?

rosey rash from trunk going to extremities

What is standard prophylaxis for family members of ppl with TB?

usually ppl get isoniazid



if that is not sensitive then give rifampin is used

What is duration of prophylaxis in pts with latent TB?

6 months for children



4 months for adults

do you need to isolate a person who has vzv zoster?

yes until the lesions are crusted over

What to do if pt is pregnant on HAART?



Do we continue HAART?

yes continue HAART(even efavirenz)



if not yet started --> start HAART



except efavirenz ( which can be started at 8 weeks and on)

Why is efavirenz bad in pregnancy?

it can cause neural tube defects

which HIV moms should get a C section?

only if viral load >1000, else



vaginal delivery is fine

What is ectyma gangrenosum?

ICU patients get foley placed ot pts who get pseudomonas sepsis



sometimes they develope a large black boil that necrosis on skin



--->

What is pyoderma gangrenosum, what is it?

deep ulcers on legs and elbow with violaceous patches

What is treatment for ecthyma gangrenosum?

zosyn



and ceftazidime

What is common cause of PNA in neonates?

chlamydia

What are other causes of infection by chlamydia in neonate?

conjunctivitis



direct contact with vagina

what does CXR look like for chlamydia PNA?

staccato cough




hyperinflation in CXR but none on fluid

What is treatment for chlamydia infection in neonate?

14 day PO erythromycin

How to describe the cryptococcus cutaneous version?

red colored papules of varying size and central umbilication

What is the frist test to do once you see cryptoccus skin manifestations?

you have to do biopsy and acid schiff stain and silver stain



do not select CSF tests and serum antigen tests first

When to give UTI's pts prophylaxis if they get recurrent infections?

if pt has 2 infection or more in 6 months




just give for 6-12 months maximum

What are the types of necrotizing fascitis?

type II most common---> pt of normal health --> pt get injury--> infection by streptococcus group A



Type 1 --> DM or other health probs usually pt gets infected by staph aureus, Ecoli, pesudomonas, step A



if there is crepitus in any of these types, its called C. perferingins infection automatically

What is treatment for nec fasc before cultures come back?

zosyn (group A strep)



vancomycin (staph)



clindamycin (toxin of strep)

What to do if pt comes in for PNA--> found to have TB, and now nurses need evlauation for TB?

give PPD to nurses now if negative, given again in 3 months



if they are positive on ppd , then isoniazid for 6 months

What is seen on speculum exam for trichomonas?

strawberry cervix

How are the viral load and CD4 count used clinically?

CD 4 is showing damage that already has been done




viral load shows damage that is about to occur

When to not give vzv to vaccine?

anaphylaxis to neomycin and gelatin



innunodeficient state

When not to give vzv vaccine?

when you have anaphylaxis to neomycin and gelatin



or when you are in an immunodeficient stat like CD 4<200

When is hep C RNA PCR vs Hep C antibodies useful?

hep C RNA useful when initial infection




Hep C antibodies positive after 12 weeks of initial infection

When is HIV ELISA vs HIV RNA PCR vs HIV IgM antibodies vs western blot useful?

first test is ELISA



2nd test if ELISA test is confusing or if you still have high clinical suspicion you should do HIV RNA pcr and p24 antigen testing

How frequently to do and ELISA?

now--> 6 weeks-->12 weeks-->24 weeks

How often to do CD4 count/ HIV load on patients not on HAART?

do Q 3-4 months to see if they need HAART

Immigrant + hematuria + microcytosis + dysuria + urinary frequency?

most likely schistosomiasis

How to officially diagnose schistosomiasis?

get eggs in the urine or feces under microscopy

What to do if patient is suspected with line infection?

if immunocompromised you need to start vancomycin + 3rd generation cephalosporin



if not immunocompromised--> just start vancomycin



lastly remove catheter after 72hrs of antibiotics therapy if patient still having signs of sepsis or hemodynamically unstable

15 yrs old with sore throat fever, fatigue nausea started 3 days ago + posterior cervical and anterior lymphadenopathy and exudates in the throat what is it?

infectious mononucleosis

When a tick bites you , what is your chance of lyme disease?

<1.5%



they have to be attached yo you for >24 hrs before they can infect you.

What is complication of appendectomy surgery that causes fevers and dry cough? What test to do to confirm it?

it can be a PNA but also think subphrenic abscess .




so get an abdominal ultrasound , not a CXR immediately

What is the difference between smear microscopy + sputum culture and nucleic acid for TB amplification ?

smear microscopy= tells you about active infection, cannot say if TB or other mycobacterium



suputum cultre takes 3-8 weeks, but it is the gold standard and drug sensitivities



nucleic acid amplification = can differ non TB mycobacterium from TB but is positive after treatment

What does antihep C antibodies positive mean?

it means that you may have cleared the infection, or you still have it or its false



if you have an antigen Hep C positive too then you can say he has an infection

What is community acquired PNA treatment in old ppl?

ceftriaxone ( S. pneumoniea)



azithromycin( leigionella)



If someone calls in and they are sick, but he can't get to hospital until later what to do?

call 911 for him and bring him in



do not wait for someone to go check on him

What is syphillis treatment?

if <12 months and no gummas


= benzathines penecillin IM single dose



if > 12 months or of unknown duration, or has gummas/ cardiac lesions


= B penecillin IM Qweekly X 3 weeks




if neurosyphillis --> then IV penecillin Q4hrs for 10-14 days



if congential syphillis 50,000 units /kg IV Q8 -12 hrs for 10 days

What is alternative to penecillin in syphillis treament?

ceftriaxone




or



tetracyclines

What is an alternative to penecillin treatment for syphillis?

ceftriaxone



or tetracyclines

After starting penecillin, pt being treated for syphillis, they get sick with myalgias and fever and what is this in syphillis pts?

called jarish Hershheimer rxn




you get extra immune system punch while it kills off the syphillis after starting antibiotics

What is the initial treatment and 2nd line treatment for otitis media?

amoxicillin---> first line



2nd line


augmentin


cefuroxime


ceftriaxone

What if after one round of treatment you see tympanic membrane full what is it and what to do?

probably a middle ear effusion




if it starts to drain out, then treat with a second line antibiotics too.



else if it doesn't drain then just leave it.

What the proper and effective isolation for C. Diff?

isolation with ahdn washing only

DKA with mucormycosis get waht treatment?

amphotericin B and debridement



what fungus class causes mucormycosis?

zygomycetes causes this infection

What are the CXR findings for active TB vs latent TB?

latent TB


-- may be negative or it might have a calcified granuloma



active TB


-- will have CXR showing upper lobe infiltrates


cavities, hilar lymphadenopathy pleural effusions

If PPD + and CXR- and pt already once given isoniazid for 9 months wht to do again when ppd+?

no need to treat again as long as CXR is negative and pt not having symptoms



How is the pneumoccoal vaccine given?

if age 19-64 pt has typical problems like DM/ liver probs, CAD/ CHF lung/ COPD/ smoker/ alcoholic


then just give the PPSV23 version



if age 19-64 and pt is really sick


like HIV sickle cell, CKD, malignancy CSF probs, and ear implants


then give PCV13 and PPSV 23



if age >65 give PCV 13 then 6-12 months later get PPSV 23

How to give the diptheria vaccine?

Tdap childhood 5 X vaccine seeries by school age



then



Td at 10-12 yrs



then Q 10 yrs after that

What is the antibiotics for lactational mastitis?

usually due to staph mssa so do dicloxacillin and nacficillin PO



What is a common cause of lactation mastitis?

improper positioning when lactating



hence you should reeducate patient about proper positioning

What is treatment for lactation mastitis other than just antibiotics?

breast feed bilaterally or squeeze breasts bilaterally



+ give antibiotic

What is treatment for strep throat? and why do you get it?

penecillin or amoxicillin




for 10 days



to prevent rheumatic fever

What does exam of the throat look like in strep throat?

tonsillar erythema and exudates



tender anterior and cervical lymph nodes




no cough but lots of sore throat

What body of fluids are dangerous for HIV transmission?

genital secretions



CSF and synovial fluids, pleural and peritoneal fluids



any solution with obvious gross blood



urine and sweat dont count unless there is blood in it

What is treatment for BV in females?

treat pt with metronidazole X 1 dose

What is more important in pyelonephritis treatment if vitals are stable antibiotics or ultrasound?

antibiotics first then ultrasound next

Who gets invasive aspergillus infections?

acute graft vs host disease pts



and allogenic bone marrow transplants

What is typical presentation of aspergillus in bone marrow transplants?

lung PNA



sinuses causing nose bleeds + headaches

What antibiotics are used for UTI during pregnancy?

nitrofurantoin




else amoxicillin and augmentin or cephalexin


What antibiotics are used for pregnancy pt who has pyelonephritis?

cephalosporin 3rd gen



or ampicillin



or gentamicin



aztreonam

What is initial treatment for cryptococcus meningitis?

amphotericin B



+ flucystosine 10-14 days




next remove large amounts of CSF with repeat LP's for symptomatic releif




What is to be done once initial amphotericin B treatment is done for cryptococcal meningitis?

start fluconazole until CD 4 cell counts improve




When is HAART therapy restarted for cyptocossus infected pts?

4-10 weeks after initial amphotericin B therapy




this is to prevent IRIS

What is preferred treatment for prostatitis first line and 2nd line?

prostatitis= ciprofloxacin or levofloxacin




2nd line is bactrim




all for 6-12 weeks




How does chagas disease affect the heart?

ventricular apical aneurysm




mural thrombus




fibrosis of the myocardium causing arrythmias

How does chagas affect the gut?

dilation of esophagus + colon

What organism is in chagas disease?

trypanosoma cruzi in mexico and in south america

What if the nurse stuck by HIV pt with low viral load anf normal CD4 count wht to do?

treat with 2 NRTI's X 4 weeks

What if the nurse stuck with HIV pt with high viral load and low CD4?

2 NRTI's and 1 protease inhibitor for 4 weeks

What reduces catheter infection rates? which Iv placements are worse for infection?

location



wrist worse than femoral worse than internal jugular




daily chlorhexidine care reduces infections


+ clean side before and clean hands while placing IV


What are options for chlamydia treatment during pregnancy?

azithromycin 1gm X 1 dose




erythromycin 500mg QID X 7 days

Recent cave visit--> hates drinking water--> feels like throat closing--> drooling from mouth--> what is this?

pt got rabies from bats in the cave

What is the most classic symptom of rabies?

hydrophobia due to spasms in pharynx that scare you from drinking

What are neurological defecits from rabies?

ascending flaccid paralysis


What is the prognosis of rabies pts once the hydrophobia sets in?

usually neurological death from respiratory failure in a couple of weeks


If mom or dad is hep B positive and baby is vaginally delivered what to do?

give immuniglobulin and hep B vaccine at birth




then 1 month, then 6 months then 12 months

When do you check hep serologies on newborn to make sure they don't have Hep B?

9-12 months

What to do if you suspect monomucleosis and you get negative monospot test?

you get antibodies for EBV

When do you use corticosteroids in EBV infection?

when SOB due to lymphadenopahy



when aplastic anemia



or EBV causing thrombocytopneia



you want to give prednisone

When do you strongly suspect C. diff but pt has negative C diff toxins can you do to confirm? what do you find on this test?

you can do a colonoscopy or a sigmoidoscopy




raised yellow plaques




also possible is c. Diff PCR which is much more accurate than the enzyme immuno assay that is initially done.

What antibiotics most common cause of C. Diff?

floroquinolones



penecillins



cephalosporins



clindamycin

child with murmur and choreathetoid movements + facial grimacing + feet jerking + emotional lability( raising voice randomnly)?

rheumatic heart disease with syndhams chorea

What is the main diagnostic rules for rheumatic heart fever?

J= joints



Carditis



Nodules subcutaneous



Erythema marginatum



1 above criteria



+



fever, arthralgias, ESR, CRP, prolonged PR, two of these

What is the treatment of rheumatic fever?

penecillin to get rid of strep group A +/= corticosteriods for severe cases

If never had risk fro rabies but now going to risk territories what prophylaxis to give?

give rabies vaccine series 0 7 21 28 days( over 1 month)

If never vaccinated for rabies and got possibly exposed what to do for treatment?

vaccine 0,3,7,14 days (quicker series than just prophylaxis vaccine days only over 2 weeks)



+


immunoglobulin on day 0



If already rabies vaccinated and got rexposed to rabies what to do?

give again rabies vaccine 0,3

When to give antibiotics for dog and cat bites?

deep puncture wounds



severe crush injury



face hands genetic on bone or joint bites



open gashes



immunocompromised pts.

What bug is common in cat bites?

pasturella multocida

What is first line and 2nd line drugs for cat and dog bites?

augmentin



+



2nd line is bactrim (gram negative)


+ clindamycin anarobes

Vesicles on posterior tongue and mouth vs anteiror tongue and mouth?

posteiror = herpangina



anterior= herpes gigivostomatitis



Where do apthous ulcers happen?

recurrent ulcers on anterior oral mucosa



on lips, cheeks, mouth floor, ventrum of the tongue


What virus causes herpangina?

coxsackie group A