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154 Cards in this Set
- Front
- Back
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 |