Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
202 Cards in this Set
- Front
- Back
|
bugs for nosocomial pneumonia
|
gram - rods
staph aureus |
|
|
breath sounds heard on inspirationa nd expiration with gap in between
|
bronchial
|
|
|
bronchial breath sounds can indicate
|
consolidation
cavity upper level of pleural effusion upper lobe fibrosis upper lobe collapse |
|
|
bugs for atypical pneumo
|
mycoplasma
chlamydia |
|
|
gram - rods
|
klebsiella
enterobacter |
|
|
how to differentiate pneumo from bronchitis
|
CXR
|
|
|
normal pulse in setting of high fever
|
atypical CAP
|
|
|
alcholic with pneumo
|
klebsiella
|
|
|
immigrant with pneumo
|
TB
|
|
|
nursinghome resident with pneumo
|
pseudomonas
|
|
|
HIV patient with pneumo
|
PCP
MTB |
|
|
organ transplant pt with pneumo
|
legionella
|
|
|
renal failure pt with pneumo
|
legionella
|
|
|
chronicl lung disease pt with pneumo
|
legionella
|
|
|
smoker with pneumo
|
legionella
|
|
|
sliver stain
|
PCP
|
|
|
test for legionella
|
urinatry antigen
|
|
|
rx for atypicals
|
macrolides
doxy fluoroquinolones |
|
|
rx for atypicals in older patients with comorbidities
|
2nd or 3rd gen cepalosporin
or amox/clavulanic 2nd generation macrolides levo, moxifloxacin |
|
|
bugs for lung abscess
|
oral anaerobes (prevotella, peptostrep, fusobacterium, bacteroides)
other (s aureus, s pneumo, aerobic gram- bacilli |
|
|
rx for lung abscess with gram pos cocci
|
ampicillin or augmentin
unasyn (ampicillin/sulbactam) vancomycin for s auerus |
|
|
rx for lung abscess with anaerobes
|
clindamycin or metronidazole
|
|
|
rx for lung abscess with gram negatives
|
fluoroquinolone or ceftazidime
|
|
|
tb with prurulent sputum, apical rales
|
secondary active tb
|
|
|
Ghon focus
|
calcified primary focus of TB
|
|
|
Ranke's complex
|
calcified primary TB focu and calcified hilar node
|
|
|
hematogenous dissemination of TB
|
miliary
|
|
|
induration for positive TB in general population
|
15 mm
|
|
|
induration for positive TB in HIB, active TB in close contacts, CXR showing primary TB
|
5 mm
|
|
|
induration for TB in high prevalence areas
|
10mm
|
|
|
bugs for neonatal meningitis
|
group B strep
e coli listeria |
|
|
bugs for kids' meningitis
|
neisseria
strep h flu |
|
|
bugs for adult meningitis
|
s pneumo
n meningitidis h flu |
|
|
bugs for elderly meningitis
|
strep
neisseria listeria |
|
|
bugs for meningitis in immunocomp
|
listeria
gram - bacilli strep pneum |
|
|
groups that get listeria meningitis
|
neonates, elderly, immunocomp
|
|
|
bug for meningitis with purpura
|
neisseria
|
|
|
sensitivity of kerning and brudzinski
|
50%
|
|
|
cloudy CSF
|
pyogenic keukocytosis
|
|
|
csf with
elevated WBCs, protein low glucose |
bacterial
|
|
|
CSF with
increased mononuclear cells protein normal or slightly elevated glucose normal CSF could be normal |
aseptic meningitis
|
|
|
when not to do an LP for meningitis
|
focal neuro signs
evidence of space occupying lesion |
|
|
empiric tx for neonatal bacterial meningitis
|
cefotaxime and ampicillin and vanc
aminioglycoside if less than 4 wks |
|
|
empiric tx for bacterial meningitis in 3 mo to 50 yr
|
ceftriaxone and vanc
|
|
|
empiric tx for bacterial meningitis in > 50
|
ceftriaxone and vanc and ampicillin
|
|
|
empiric tx for bacterial meningitis in HIV
|
ceftazidime and ampicillin and vanc
|
|
|
which meningitis patients get vanc empirically?
|
all
|
|
|
which meningitis patients get ampicillin empirically
|
all but 3 mo to 50 years
|
|
|
what do asplenics need vaccination for?
|
s pneumo
neisseria h flu |
|
|
rx for bacterial meningitis prophylaxis
|
rifampin or ceftriaxone
|
|
|
at what t cell count do HIV patients get toxo encephalitis
|
200
Toxo at Two hundred |
|
|
headache
malaise myalgias frequently have signs of meningitis altered sensorium focal neuro findings |
encephalitis
|
|
|
LP with >5 WBC and normal glucose, cultures negative, with suspected encephalitis
|
viral encephalitis
|
|
|
how best to diagnose encephalitis
|
CSF PCR, esp for HSV, CMV, EBV, VZV
|
|
|
What kind of encephalitis is EEG useful for
|
HSV-1 (shows unilateral or bilateral temporal lobe discharges
|
|
|
tx for HSV encephalitis
|
acyclovir for 2-3 weeks
|
|
|
tx for CMV encepalitis
|
ganciclovir or foscarnet
|
|
|
tx for viral encephalitis
|
none
|
|
|
brain absceses in neutorpenic patients (bugs)
|
candida
aspergillus zygomycosis |
|
|
change in mental status
seizure nausea vomiting nuchal rigidity fever and chills may be absent |
brain abscess
|
|
|
Hep b is associated with
|
PAN
|
|
|
hep C is associated with
|
cryoblobulinemia
|
|
|
other hepatitis viruses, esp in immunocompromised
|
EBV
CMV HSV |
|
|
HBeAg means
|
infectivity
|
|
|
anti-HBc means
|
window period
|
|
|
does absent Heb C Ab rule out infection?
|
no
|
|
|
what is acute illness like for Hep B and C?
|
little
|
|
|
asterixis
palmar erythema |
hepatic encephalopathy
|
|
|
transaminases over 500
|
acute viral hepatitis
shock liver drug induced hepatitis |
|
|
how to diagnose hep C
|
PCR, because antibody may be absent for months
|
|
|
AST < ALT
|
hepatitis
|
|
|
AST > ALT
|
alcoholic cirrhosis
|
|
|
HBV Tx
|
interferon or lamivudine
|
|
|
HCV Tx
|
interferon and ribavirin
|
|
|
symmetric descending flaccid paralysis that starts with dry mouth, diplopia, dusarthria
|
botulism
|
|
|
ascending paralysis
|
guillain Barre
|
|
|
tx for botulism
|
administer toxoid
|
|
|
main UTI bugs
|
e coli
saprophyticus enterococcus |
|
|
fever in lower UTIs, upper UTIs?
|
absent usually in lower
|
|
|
urine with positive LE
|
pyuric
|
|
|
urine with positive nitrites
|
gram negative
|
|
|
how many bacteria for UTI
|
>100,000, or 100 if clinical symptoms present
|
|
|
tx of simple cystitis in nonpregnant women
|
bactrim for 3 days, or cipro
|
|
|
tx of simple cystitis in pregnant woman
|
ampicillin, amoxicillin
oral cephalosporin NO CIPRO!!! (fetal arthropathy) |
|
|
when do you give pyelonephritis prophylaxis
|
if 2 or more UTIs per year
|
|
|
who gets emphysematous pyelo
|
diabetics
|
|
|
leukocyte casts
|
pyelonephritis
|
|
|
tx for uncomplicated pyelo
|
gram neg: bactrim or fluro for 10 to 14 days
gram pos: amoxicillin |
|
|
tx of pyelo with urosepsis
|
IV abx for 2-3 weeks
|
|
|
tx of recurrent pyelo
|
6 weeks if same organism
2 weeks if different organism |
|
|
what shouldn't you do toa man with bacterial prostatitis
|
avoid prostatic massage because it may cause bacteremia.
Skip rectal exam |
|
|
abx for acute prostatitis
|
bactrim
or fluoro plus doxy |
|
|
main bug for reiters
|
chlamydia
|
|
|
bug that is leading cause of infertility in women
|
clamydia
|
|
|
tx for chlamydia
|
1 dose azithro
or 7 days doxy |
|
|
fever, arthralgias, tenosynovitis
migratory polyarthritis skin rash on distal extremities |
gonorrhea
|
|
|
diagnosis of gonorrhea
|
gram stain with organisms within leukocytes
|
|
|
tx for gonorrhea
|
ceftriaxone (which also protects against syphillis)
and azithro or doxy for chlamydia |
|
|
fever
sweats malaise lethargy headaches diarrhea sore throat truncal maculopapular rash |
primary HIV
|
|
|
test for HIV
|
ELISA and Western blot follow-up
|
|
|
when do hiv patients get MAC or CMV
|
<50
|
|
|
how to diagnose toxo
|
CT with contrast
|
|
|
how to diagnose crypto
|
india ink
|
|
|
tx for crytpto
|
amphotericin for 10-14 days
plus 8-10 weeks of fluconazole followed by lifetime fluconazole maintenance |
|
|
bug for hairy leukoplakia
|
EBV
|
|
|
when do CVM and HSV esophagitis happen in HIV patients
|
<100
|
|
|
tx for CMV retinitis
|
ganciclovir or foscarnet
|
|
|
do you continue HAART in pregnant patients
|
yes
|
|
|
MAC prophylaxis in HIV patients
when? what? |
at CD4 <100
clarithromycin and azithromycin |
|
|
drugs for toxo prophylaxis
|
bactrim
|
|
|
what vaccines to avoid in HIV patients
|
live virus vaccines
|
|
|
baby born with
malformations intrauterine growth retardation chorioamnionitis neonatal death |
HSV
|
|
|
how to treat herpetic whitlow
|
acyclovir
|
|
|
gold standard HSV diagnosis
|
culture - swab base of ulcer. results in 2-3days
|
|
|
maculopapular rash
flu like illness |
secondary syphilis
|
|
|
when is syphilis contagious
|
primary, secondary
|
|
|
gummas
dementia personality changes tabes dorsalis |
tertiary syphillis
|
|
|
what does tabes dorsalis involve
|
posterior column degradation
|
|
|
syphilis dianosis
|
VDRL and RPR
if positive confirm with FTA-ABS |
|
|
what gives false positive VDRLs or RPRs
|
SLE
|
|
|
bug for chancroid
|
haemophilus ducreyi, a gram neg rod
|
|
|
painful genital ulcer
|
HSV
Chancroid |
|
|
coalescing granulomatous inguinal ulcers
|
granuloma inguinale
|
|
|
inguinal adenopathy
|
primary syphilis
primary HSV chancroid lymphogranuloma (2-6 weeks later) granuloma inguinale |
|
|
unilateral inguinal lymphadenopathy
|
chancroid (usually)
lymphogranuloma venerium (2/3) |
|
|
tx for chancroid
|
azithro
erythro cipro |
|
|
bug for lymphogranuloma venereum
|
chlamydia
|
|
|
tx for lice
|
permetrhin 1% shampoo
|
|
|
tx for cellulitis and erysipelas
|
oxacillin
nafcillin cefazolin |
|
|
bug for erysipelas
|
group A strep
|
|
|
cellullitis confined to dermis and lymphatics
|
erysipelas
|
|
|
how to differentiate DVT from cellulitis
|
DVT
(Homan's sign and palpation of venous cords not sensitive) |
|
|
bugs for necrotizing fasciitis
|
strep pyo
clostridium |
|
|
what is tetanus toxin
|
exotoxin
|
|
|
tetanus incubation
|
TeTanus Two days To Two weeks
and then onset of symptoms is graudal (1-7 days) |
|
|
tx for tetanus
|
diazepam for tetany
respiratory support passive immuno with TIg active immuno with Td clean adn debride Metro and Penicillin G |
|
|
bug for osteo with catheter
|
s aureus
|
|
|
bug for osteo with prosthetic joint
|
coag negative staph
|
|
|
bug for diabetic foot ulcer
|
polymicrobial
|
|
|
bug for nosocomial osteo
|
pseudomonas
|
|
|
bug for osteo in IV drug user or neutropenia
|
fungal
pseudomonas |
|
|
osteo in vertebra
|
Pott's disease, TB
|
|
|
how to diagnose oseto
|
MRI
|
|
|
tx of acute bacterial arthritis in healthy adult
|
parenteral oxacillin or 1st gen cephalosproin, 4 weeks
vanc if MRSA suspected |
|
|
tx of acute bacterial arthritis in immunocompromised or sig gram negative risk
|
parenteral ceftriaxone or aminoglycoside, 3-4 weeks
for pseudomonas use aminoglycoside (gentamycin) plus extended spectrum penicillin (tazobactam) |
|
|
tx for acute bacterial arthritis in young adult with gonogoccal presentation
|
ceftriaxone until clinical improvmenet and then cpro for 10 days once improving
|
|
|
lyme patient with IgM?
|
acute
|
|
|
lyme patient with IgG
|
disseminated Lyme
|
|
|
meningitis with negative Brudzinski/Kerning
|
Lyme
|
|
|
rx for pregnant patient with Lyme
|
erithromycin instead of doxy
|
|
|
malaria with constant fever
|
falciparum
|
|
|
malaria with 48 hour spikes
|
ovale, vivax
|
|
|
malaria with 72 hour spike
|
malariae
|
|
|
diagnosis for malaria
|
blood smear with Giemsa stain
|
|
|
tx for malaria
for falciparum? |
chloroquine
or quinine and tetracycline or atovaquone, proguanil and mefloquine falciparum may need quinidine and doxy |
|
|
malaria prophylaxis
|
chloroquine
or mefloquine in chloro-resistant areas |
|
|
negri bodies
|
rabies
|
|
|
bug from rodents and farm animals
|
leptospirosis
|
|
|
reservoir is rodents, farm animals
transmission is contaminated water bug and tx |
leptospirosis
tetra or doxy if severe, penicillin G |
|
|
deer reservoir, tick bit transmission (not Lyme)
bug and tx |
ehrlichiosis (intracellular gram-)
tetra or doxy |
|
|
rabbits or other rodents reservoir
tick bit, animal bit, handling carcass transmission bug and tx? |
tularemia - francisella tularensis (gram - bacillus)
IM streptomycin or gentamycin |
|
|
farm animal reservoir;
transmission: blood, ingestion of infected milk, inhalation |
Q fever - coxiella burnetti (gram-)
acute:doxy or fluroquinolone chronic: rifampin |
|
|
reservoir: cats, fleas
transmission: scratch from flea-infested cat |
Cat scratch: bartonella (gram- bacillus)
|
|
|
aspergillosis tx
|
amphotericin
voriconazole caspofungin |
|
|
pigeons give risk for
|
crypto
|
|
|
crypto tx
|
2 wks ampho and clucytosine
then fluconazole |
|
|
mississippi river valley
bird/bat droppings |
histoplasmosis
|
|
|
appearance of histo
|
dimorphic fungus with septate hyphae
|
|
|
tx for histo
|
PO itraconazole
amphotericin if severe infection or immunocompromised host |
|
|
american southwest
spores |
coccidiodomycosis
|
|
|
tx for cocco
|
PO fluconazole or itraconazole for 6 mos
IV amphotericin B for severe or immunocompromised |
|
|
spore inhalation in south east
|
blasto
|
|
|
invasion of skin by thorn or other plant material; seen in a gardener
|
sporotrichosis (sporothrix schenckii)
|
|
|
cigar shaped yeast
|
sporothrix - sporotrichosis
|
|
|
dimorphic fungus with septate hyphae
|
histo
|
|
|
severe watery diarrhea in an immunocompromised host
|
crypto sporidium
|
|
|
tx for crypto
|
supportive
|
|
|
bloody diarrhea
tenesmus abdominal pain possible liver abscess |
amebiasis (entamoeba)
|
|
|
tx for amebiasis
|
iodiquiniol or paromomycin
metronidazole for liver avscess |
|
|
tx for giardia
|
metronidazole
|
|
|
postprandial pain or vomiting
can cause bowel, pancreatic duct, CBD obstruction |
ascariasis
|
|
|
tx for ascariasis
|
albendazole
mebendazole pyrantel |
|
|
cough
anemia malabsorption weight loss eosinophilia |
hookworm (ancylostoma or necator)
|
|
|
tx for hookworm
|
mebednazole or pyrantel
|
|
|
perianal pruritis, worse at night
|
pinworm
|
|
|
fever and actue diarrhea leading to liver fibrosis, portal HTN in chronic form
|
schistosomiasis
|
|
|
tx for schistosomiasis
|
praziquantel
|
|
|
txf or tapeworm
|
praziquantel
|
|
|
drugs causing fever
|
sulfonamides
penicillin quinidine barbiturates diet iplls with phenolphthalein |
|
|
hyperthermia vs fever
|
hyperthermia involves no change in the hypothalamic set point and is caused by inability of body to dissipate heat
|
|
|
how to treat hyperthermia
|
no antipyretics
external colling (ice fans) rx specific to cause (dantrolene for malignant hyperthermia) |
|
|
criterion for TSS
|
involves Three SystemS
|
|
|
tx for TSS
|
nafcillin or
oxacillin or vancomycin |
|
|
bug for acute bronchitis
|
viral
|
|
|
bug for acute sinusitis
|
viral
s pneumo h flu m catarrhalis |
|
|
bug for chronic sinusitis
|
s aureus
anaerobes |
|
|
bug for subacute endocarditis
|
strep viridans
|
|
|
bug for acute endocarditis in IV drug user
|
s aureus
gram neg rods enterococcus yeast |
|
|
bug for acute endocarditis with prosthetic valve
|
s epidermidis
|
|
|
bug for intra-abdominal infection
|
enterococcus
bacteorides e coli |
|
|
neutropenic fever
|
bone marrow failure (toxins, drugs)
bone marrow invasion (malignancy) hypersplenism SLE AIDS agranulocytosis (drugs) |
|
|
fevers
chills fatigue headaches splenomegaly negative hereterophile antibodies no cervical lymphadenopathy and no pharyngitis |
CMV mono
|
