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50 Cards in this Set
- Front
- Back
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physical exam signs of pneumonia
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decreased or bronchial breath sounds (decreased air movement), rales, wheezing, dullness to percussion, egophony, tactile fremitus
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tests for Legionella pneumonia
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Urine Legionella antigen test,
sputum staining with direct fluorescent antibody, culture |
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tests for Chlamydia pneumonia
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serologic testing, culture, PCR
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tests for Mycoplasma pneumonia
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usually clinical,
serum cold agglutinins, serum Mycoplasma antigen can also be used |
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diagnostic workup for pneumonia
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CXR, physical exam, CBC, sputum gram stain and culture, blood culture, ABG
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lancet-shaped diplococci
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strep pneumoniae
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risk factors for TB
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immunosuppression, alcoholism, pre-existing lung dz, DM, advancing age, homelessness, crowded living conditions (prison), immigrants, health-care workers, "sick contacts"
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diagnosis of TB (and details for each)
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acid-fast sputum stains: 3 AM samples (if negative and still high suspicion, go for bronchoscopy with BAL or bx)
-CXR: lower lobe infiltrates in primary TB, apical fibronodular infiltrates with or without cavitation in reactivated pulmonary TB -PPD (positive shows previous exposure; exposed immunocompromised pts may not mount a response-anergy) |
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miliary TB charactersitics
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multiple fine nodular densities distributed throughout both lungs
-represent hematologic or lymphatic dissemination, esp common in HIV |
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trx of TB
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directly observed multidrug therapy with 4-drug regimen (INH, rifampin, pyrazinamide, ethambutol) until drug susceptibility tests finalized
-Vit B6 with INH to prevent peripheral neuritis |
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mnemonic for TB trx
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RIPE
Rifampin INH Pyrazinamide Ethambutol |
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duration of rifampin and INH therapy?
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6 months
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duration of prophylactic TB therapy and under what conditions to start therapy
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-PPD conversion without active Sx in pts with CXR suggestive of old TB infection, recent new conversion (<2 yrs), or pts with risk factors for TB
-INH for 9 months, NO EtOH |
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Side effects of:
rifampin? ethambutol? INH? |
Rifampin: turns body fluids orange
-Ethambutol: optic neuritis -INH: peripheral neuritis and hepatitis |
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interpretations for size of induration of PPD test
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>5mm: HIV or risk factors, close TB contacts, CXR evidence of TB, high index of suspicion
>10mm: indigent/homeless, residents of developing nations, IV drugs, chronic illness, residents of health and correctional institutions, health care workers >15mm: everyone else w/no known risk factors |
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what does negative PPD reaction with negative controls mean
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anergy from immunosuppresion, old age, or malnutrition
-does not r/o TB |
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typical sx of strep pharyngitis
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fever, sore throat, pharyngeal erythema, tonsillar exudate, cervical LAN, soft palate petechiae, HA, vomiting, scarlatiniform rash (indicating scarlet fever)
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Centor criteria
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for strep pharyngitis
-erythema -exudate -tender ant cervical LAN -lack of cough |
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dx of acute pharyngitis
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clinical eval,
rapid GAS antigen detection, throat culture (Centor criteria) |
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nonsuppurative complications of GAS/strep pharyngitis
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acute rheumatic fever,
post-strep GN |
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suppurative complications of GAS/strep pharyngitis
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cervical lymphadenitis, mastoiditis, sinusitis, OM, retropharyngeal or peritonsillar abscess
-rarely, Lemierre's syndrome (thombophlebitis of jugular vein) d/t Fusobacterium (oral anaerobe) |
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Lemierre's syndrome
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thrombophlebitis of the jugular vein, d/t Fusobacterium, an oral anaerobe
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signs and symptoms of peritonsillar abscess?
trx? |
-odynophagia, trismus (lockjaw), muffled voice, unilateral tonsillar enlargement, erythema with the uvual and soft palate deviated away from the affected side
-antibiotics and surgical drainage |
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duration of acute sinusitis and causes
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< 1month of sx
-S. pneumo, H. influenzae, M. catarrhalis -viral |
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duration of chronic sinusitis and causes
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> 3 months
-obstruction of sinus drainage -ongoing low-grade anaerobic infections -mucormycosis in diabetic pts |
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gold standard for diagnosis of sinusitis
-what other tests done |
bacterial culture by sinus tap (not routinely performed)
-CT scan of sinuses -MRI to differentiate soft tissue (like a tumor) from mucus |
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duration of treatment for acute sinusitis
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10 days
-Augmentin 500mg PO TID x10days -Clarithromycin, azithromycin, TMP-SMX, or 2nd gen cephalosporin x10 days |
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in what patient epidemiology to consider coccidioidomycosis
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HIV-positive, Filipino, black or pregnant pts from southwestern US with respiratory infection
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how can disseminated coccidioidomycosis
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meningitis, bone lesions, soft tissue abscesses
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dx of coccidioidomycosis
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-Precipitin Ab (IgM) increased w/in 2 weeks and disappear after 2 months
-complement fixation Ab (IgG) increase at 1-3 months |
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trx for coccidioidomycosis
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IV amphotericin B for severe or protracted primary pulmonary infection and disseminated dz
-IV therapy rarely necessary -PO fluconazole or itraconazole for mild infection and long-term suppression |
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diagnostic tests for meningits
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blood cultures
LP, CSF gram stain and cx (glucose, protein, WBC + diff, RBC, opening pressure) CT or MRI |
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trx for close contacts of pts with meningococcal meningitis
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rifampin,
cipro or ceftriaxone prophylaxis |
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complications of meningitis
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cerebral edema, subdural effusions, ventriculitis/hydrocephalus, seizures, hyponatremia, subdural empyema, other (CN palsies, sensorineural hearing loss, coma, death)
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how does subdural empyema present (complication of meningitis)
-how to trx |
intractable seizures. requires surgical evacuation
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two most common causes of encephalitis
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HSV, arboviruses
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differential dx of encephalitis
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brain abscess, malignancy, toxic-metabolic encephalopathy, subdural hematoma, SAH
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what CSF profile suggests HSV encephalitis
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RBCs w/o history of trauma
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what does india ink show in CSF?
wet prep? Giemsa stain? |
India Ink: cryptococcus
Wet prep: free-living amebae Giemsa: trypanosome |
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how to trx HSV encephalitis?CMV encephalitis?
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IV acyclovir
IV ganciclovir +/- foscarnet |
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when to use doxycycline in encephalitis
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rocky mountain spotted fever,
lyme, ehrlichiosis |
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most common infective orgs of brain abscess
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staph, strep, anaerobes
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methods of spread of brain abscess
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direct spread d/t paranasal sinusitis (in young males, by strep milleri), OM, mastoiditis, dental infection
-direct inoculation: h/o head trauma or neurosurgical procedures -hematogenous spread: MCA distribution w/ multiple abscesses that are poorly encapsulated and at the gray-white junction |
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what org involved in direct spread d/t paranasal sinusitis, etc. in brain abscess
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Strep milleri
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what artery mainly involved in hematogenous spread in brain abscesses
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MCA distribution
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classic clinical triad of brain abscess
-how many cases does this present |
-HA, fever, focal neuro deficits
-< 50% |
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what is the most common symptoms of brain abscess
-and other main sx |
headache that's often dull, constant and refractory to trx
-increasing ICP -> CN 3 and 6 deficits d/t uncal herniation -focal neuro deficits |
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what will labs show in brain abscess
what will CSF analysis show |
-peripheral leukocytosis, increased ESR, CRP
-not necessary and may precipitate a herniation syndrome |
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trx for brain abscess
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-IV atbx (3rd-gen ceph + flagyl +/ vanco 9IV therapy for 6-8 weeks, then 2-3 weeks PO)
-get serial CT/MRIs to follow resolution -surgical drainage (aspiration or excision) |
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when to use dexamethasone in brain abscess
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dex taper used in severe cases to reduce cerebral edema
-IV mannitol may also be used |
