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71 Cards in this Set
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- Back
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Pt. cuts foot on rock in fresh water pnd, then develops indurated nodule. Initial treatment with cephalexin has failed to resolve the lesion. Organism and tx?
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Mycobacterium marinum; clarithromycin combined with ethambutol or TMP-SMX or rifampin
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Pt. with gram positive bacillus bacteremia and widened mediastinum on chest x-ray may have what organism?
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Inhalation anthrax
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Complications of inhalation anthrax
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hemorrhagic mediastinitis, hemorrhagic meningitis, and bacteremia
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Pt. presents with solitary skin papule that evolved into an eschar with surrounding edema. Gram positive bacillus isolated on culture. What is it?
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Cutaneous anthrax
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Treatment for inhalation anthrax
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Doxycycline and/or ciprofloxacin for 60 days
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Organism responsible for causing bronchitis and penumonia in COPD patients
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Moraxella Catarrhalis
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Pt develops double vision, dilated pupils, dry mouth and descending flaccid paralysis with intact sensation and DTRs, what organism and tx?
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Clostridium botulinum; equine anti-toxin
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Pt with poor dentition c/o jaw pain following tooth extraction. microscopic exam of organism reveals sulfur granules and a gram positive organism. What is organism and tx?
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Actinomyces israelii; penicillin
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Most effective abx combination for treating streptococcal necrotizing fasciitis in conjunction with debridement
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Clindamycin and penicillin
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Production of this protein accounts for rapidly advancing margins characteristic of cellultis from Beta hemolytic strep
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hyaluronidase
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5 major Jones criteria for intial attack of rheumatic fever
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PECCS: polyarthritis, erythema marginatum, chorea, carditis, subcutaneous nodules.
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Medication used to prevent recurrences of rheumatic fever
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Monthly injections of penicillin G. Oral penicillin, sulfonamides, and erythromycin are effective as well.
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Indication for endocarditis prophylaxis in those with history of rheumatic fever
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prosthetic valve
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59 year old with strep bovis bacteremia needs which screening exam? How do you tx the bacteremia?
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Colonoscopy; tx bacteremia with penicillin +/- an aminoglycoside
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Preferred tx for enterococcal endocarditis
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penicillin or ampicillin plus gentamicin or streptomycin
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Name the toxin that makes CA-MRSA so virulent and what its effect is
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Panton-Valentine leukocidin toxin; lethal to neutrophils
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CA-staph aureus bacteremia should be treated how long with parenteral abx?
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4-6 weeks.
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CA-MRSA is often susceptible to which abx?
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Clindamycin, tetracyclines, TMP-SMX
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Common cause of urinary tract infections in young sexually active women
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Staphylococcus saprophyticus (coagulase negative)
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Patient with coagulase negative staphylococcal endocarditis should be put one what tx regimen?
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Vancomycin + Rifampin for six weeks with gentamicin for the first 2 weeks.
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Enterobactor and Serratia species are usually resistant to 3rd gen cephalosporins. What can be used instead?
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Carbapenems, fluoroquinolones, cefepime, tmp-smx.
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DOC for treating Klebsiella infections
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3rd generation cephalosporins
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Two organisms that most frequently cause infections of massive burns?
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Pseudomonas aeruginosa and S. aureus
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Necrotizing skin lesion seen neutropenic patients with P. aeruginosa bacteremia?
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Ecthyma gangrenosum
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Agents with activity against P. aeruginosa
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Piperacillin, ticarcillin, aminoglycosides, ceftazidime, cefepime, azteronam, meropenem, imipenem, ciprofloxacin
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DOC for gram negative bacilli meningitis
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Cefotaxime or ceftriaxone (DOC for H. inflluenzae)
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20 y/o patient with persistent cough found to have severe lymphocytosis on CBC should be treated with what abx directed at which organisim?
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Macrolides (erythromycin, clarithromycin, or azithromycin) for 14 days directed at Bordetella pertussis
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Close contacts exposed to a patient sick with bordetella pertussis should receive what tx and for how long?
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Macrolide for 5 days.
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Patient who lives in Texas with prolonged unexplained fever has "sterile" pyuria on testing. Imaging reveals splenic calcifications. Blood cultures show gram negative bacillus. Organism and tx
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Brucella; tx with doxycycline along with streptomycin or rifampin. TMP-SMX may be a choice
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63 y/o man on chronic corticosteroids presents with fever, dry cough, diarrhea. CXR shows pathcy bilateral infiltrates. Labs show hyponatremia and mild increase in LFTs. Organism and therapy
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Macrolides or fluoroquinolones. For likely legionella infection.
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Patient from Wisconsin presents after deer hunting and being bitten by a tick with high fevers and an eschar at the site of his tick bite. The bite occurred on his upper back and there is regional lymphadenopathy. Organism and tx?
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Francisella tularensis tx with streptomycin or gentamicin, doxycycline has 10% failure rate.
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Most common cause of cutaneous infection within 24 hours after a cat or dog bite?
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Pasteurella multocida; tx with tetracyclines, amoxicillin-clavulanate, or fluroquinolones
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35 y/o man presents with cutaneous infection after a dog or cat bite. On exam you notice that it appears he has developed cellulitis. Organism, gram stain characteristics, and tx?
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Pasteurella multocida (gram negative bacillus); doxycycline or amoxicillin-clavulaate, or fluroquinolones
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Sickle cell patient presents with fever, tachycardia, and hypotension a few days after being bitten by a friends dog. Initial cultures negative. Which organism should you suscpect? Tx?
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Capnocytophaga canimorsus (gram negative bacillus) tx with penicillins or cephalosporins.
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39 y/o pt reports history of kitten biting her hand. She has now developed low grade fever, malaise and a papular erythematous lesion at site of the bite. Organism, stain characteristics, and tx?
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Bartonella henselae, gram negative bacillus, tx with azithromycin, erythromycin, or doxycycline.
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Florida man with hx of alcoholic cirrhosis presents with fever,hypotension, and multiple hemorrhagic bullae. She recalls eating several raw oysters on a recent visit to Destin, FL. Tx and organism?
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Tx with ceftazidime or a tetracycline for suspected vibrio vulnificus
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Does active tatanus induce protective immunity to subsequent episodes of tetanus?
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No
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Tx of choice for anaerobic gram negative rods in suspected aspiration pneumonia and lung abscess
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Ampilcillin-sulbactam, piperacillin-tazobactam, metronidazole, or carbapenems such as imipenem or ertapenem
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Carbapenem with no activity against pseudomonal infections
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ertapenem
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Mechanism of c. botulinum toxin
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inhibits acetylcholine release from cholinergic terminals @ motor endplate
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Pt. presents with indurated nodules on her hand after cleaning the aquarium at the carwash where she works. She was given cephalexin at an urgent care clinic and told she had cellulitis, however lesions have not responded. What should you give her after stopping cephalexin?
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Combination of clarithryomycin with ethambutol, TMP-SMX or rifampin.
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Patient with 6 week history of cough presents to your office. A CXR reveals multiple discrete nodules. CT scan of the chest reveals bronchectasis. CD4 count is 100. How would you tx organism responsible for the nodules?
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Clarithromycin or azithromycin with ethambutol and rifampin or rifabutin
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Pt. presents with complaints of h/a that started suddenly. He has had fevers and chills over the last 3 days. He c/o severe muscle aches. On exam it appears he has conjunctivitis. He raises rats to feed snakes at a local zoo. Organism and tx
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Likely leptopirosis tx with penicillin G with in the first 5 days.
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Etiologic agent in Lyme disease
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Borrelia burgdorferi
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Facial nerve palsy, carditis, chorea, and conduction abnormalities are associated with which stage of Lyme disease?
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Stage 2
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Arthralgias are typically present in which stage of Lyme disease?
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Stage 3
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Diagnositic screening and confirmatory tests for Lyme disease?
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ELISA anti B. burgdorferi antibodies for screening. Confirm with western blot test.
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Agent of choice in Lyme Disease in pregnancy
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Amoxicillin or cefuroxime
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Pt. with 3rd degree heart block due to Lyme disease should be treated with what?
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Ceftriaxone or penicillin G
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An immunosuppressed pt comes in for cough with purulent sputum production, fevers, and chills. He is found to have aerobic gram positive filamentis branching organism as the cause of his infection. What is the organism, tx, and diagnostic study that should be ordered.
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Nocardia, tx with TMP-SMX, order CT or MRI of brain to r/o abscess
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Area where Rocky Mountain spotted fever is most common
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oklahoma and the mid-Atlantic states
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Characteristics of Rocky Mountain spotted fever rash
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begins on extremities and moves centrally
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Cause of Q-fever and its treatment
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Coxiella burnetti; tx with tetracyclines or flouroquinolones
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Pt. presents with fever and cough after his cat or sheep gave birth 2 days ago. Diagnosis?
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Q fever (coxiella burnetti)
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This pneumonia causing bacteria lacks a cell wall rendering penicillins useless in its tx.
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Mycoplasma pneumoniae
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Preferred tx of Mycoplasma pneumoniae infections
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macrolides, fluroquinolones, or tetracyclines
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Drug of choice for pregnant women with coccidioidomycosis infections
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amphotericin B
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DOC for life threatening histoplasmosis infections
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amphotericin B
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DOC for non-life threatening histoplasmosis infections
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itraconazole
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DOC for life threatening blastomycosis infections
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amphotericin B
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DOC for non-life threatening blastomycosis infections
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itraconazole
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Fungus responsible for rose-gardener's disease
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sporotrichosis
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Pt. sustains scrape while doing yard work. Develops crusty erythematous lesions at sight of scrape that have ascended to axillary lymph nodes. Organism and tx.
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sporothrix schenckii; itraconazole
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DOC for Aspergillus infections
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voriconazole
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An encapsuled yeast with thin walled buds is isolated from sputum culture on a patient with recent kidney transplant on immunosuppressive therapy who developed cough and fevers 5 days ago. Which diagnostic testing in addition to blood cultures should be carried out?
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Lumbar puncture for suspected cryptococcous. Perform even in abscence of menigitis symptoms.
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Preferred tx for cryptococcal infections
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fluconazole or amphotericin B (use in any immunocompromised or CNS involvement)
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Patient with AIDS develops crytococcal pneumonitis and meningitis, what is the initial tx regimen?
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Amphotericin B with flucytosine for atleast 2 weeks or more, with the addition of fluconazole after 2 weeks.
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Pt. finished her last round of chemotherapy a few weeks ago and is in remission. Her treatment course was complicated by profound N/V/D and neutropenia. She now presents with fever and abdominal pain. CMP shows increase ALP. What do you expect to see on Uls or CT of the abdomen? What is the diagnosis?
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You would expect to see bull's eye lesions on the liver; diagnosis is hepatosplenic candidiasis
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Pt presents to you with a diffuse macular rash. He was seen at an in the ED with fever, pharyngitis, and cervical adenopathy and received amoxicillin. What is the likely diagnosis?
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infectious mononucleosis
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Tx of choice for CMV infections in immunocompromised?
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Ganciclovir
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If given with in 48 hours of symptom onset this drug can reduce duration of symptoms by 1 day for the influenza A or B virus
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oseltamivir or zanamivir
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