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122 Cards in this Set
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complement disorders see on boards w what bacteria
ck lab? |
Neisseria
ck CH 50 or Ch 100 |
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localized angioedema
abdominal pain |
hereditary angioedema
usu father/daughter on boards |
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Neutropenic fever
monotherapy |
cefepine, ceftazidime, imipenem, meropenem
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Neutropenic fever
combo |
AG + AP-lactam
(ticarcillin, piperacillin, ceftazidime, cefepime or imipenem/meropenem) |
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Neutropenic fever
use vanc w which pts? |
hypotension/CV compromise
suspected IV catheter infection known colon w MRSA or resistant Pneumococcus mucositis(think herpes) |
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neutropenic fever
still febrile after 5d |
add on caspofungin or liposomal ampho B
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think of this bug in pt who has had pneumonia/recent influenza
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staph
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rash w subsequent desquamation esp palms/soles
fever, hypotension, gi muscular, liver renal involved |
TSS
usu staph or strep pyogenes remove implanted device |
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strep pneumo
intermed resistant... highly resistant/pcn/// meningitis |
IR 3rd gen ceph
HR 3rd gen ceph or add vanc meningitis vanc + 3rd gen ceph 3rd gen: rocephin or cefotaxime |
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when to tx grp B strep
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v young/old, diabetes, pregnant, alcohol
post partum endometritis |
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older man s/p turp w sepsis infection
bug tx |
enterococcus
amp/pcn or vanc if pen allergy add AG for synergy w serious infections ck sens for VRE if not better |
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neonates, elderly, pregnant
goat cheese, uncooked hot dogs think of this bug |
Listeria
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tx of listeria
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amp or pcn +/- AG for synergy/serious infections
or bactrim for PEN allergy |
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Pneumonia w widened mediastinum think:
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Anthrax
no person/person spread tx cipro or pcn/tcn |
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clostridia septicum or strep bovis
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colonoscopy
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Gas gangrene bug
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C septicum, perfringens, tetani, Novyi
look for air |
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if you are given slide w orgs that are red think
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Neisseria
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Moraxella tx
population |
emycin, tcn, bactrim, augmentin
copd or immunodeficient |
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Nail puncture thru tennis shoe bug?
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pseudomonas
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IV drug users/endo or osteo
bug tx |
pseudomonas
tx vanc/gent |
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chronic otitis externa/diabetes bug
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pseudomonoas
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ecthyma gangrenosum
what is it population tx |
round indurated black lesion w central ulceration
pseudomonas bacteremia refer, requires wide excision |
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diarrhea
chicken eggs iguanas, chicks, turtles |
salmonella
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epidemic of young people w pneumonia, hemorrhagic, febrile
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Yersinia
person/person contact |
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rabbit/tularemia
geography |
AK OK MO
ulcer at site of bite + big LN tcn, gent |
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rash fever arthralgias tick exposure
what rash? any abnl lytes? dx? tx |
rash distal palms/soles m/p to petechiae
hyponatremia acute/convalescent titers doxy, chloramphenical RMSP |
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tick
southeast/midwest sx labs dx tx |
flulike illness
PANCYTOPENIA dx serology tx doxy Ehrlichia |
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community outbreak diarrhea
self limited in nl host chronic in AIDS dx |
cryptosporidium
dx ag in stool |
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Primary syphilis
chancres when? incubation? |
painless chancres 21d after exposure
incub 10-90d lasts for up to 1 yr |
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Secondary syphilis
sx rash? |
fever malaise, genl LN, m/p rash or annular or follicular-nickle/dime rash
ALOPECIA |
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Meningeal syphilis
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occurs in first yr of infection
YOUNG PERSON W HEARING LOSS or yrs later:YOUNG PERSON W STROKE |
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Syphilis
dx |
VDRL or RPR for initial screen
confirm: FTA-ABS fluorescent treponemal ab absorbed or MHA-TP |
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syphilis tx
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early primary secondary or latent less than 1 yr
Pen G benzathine x1 doseor doxy x 2 wks. Later pen G q wk x 3 dose or doxy x 1 mo |
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Lyme dx w e migrans
do serology for dx? |
No
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Lyme dx sx
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early rash, fever HA, LN
wks/mos--meningitis or neuritis, p neuropathy Bells foot drop Heart block arthritis |
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Lyme dx
tx early tx meningitis |
doxy
menin: ceftriaxone arthritis doxy at least 2 wks |
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Candida disseminated
w central line |
take out line, start tx, then replace lilne
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Meningitis
AIDS CD4 <50 what is bug? |
cryptococcis
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sporotrichosis
population dx tx |
gardeners, multiple nodules
dx culture tx itraconazole |
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Aids
CD4<50 CNS chgs think |
toxo or lymphoma
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Banana gametophyte
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P. faliparum
most fatal of the 4 types |
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which malaria bugs relapse/
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P vivax and P ovale
need primaquine (screen for glucose 6PD before giving primaquine) |
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what bug causes "malaria in the US?"
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Babesia microti
nantucket in summer/fall |
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Maltese cross pattern/intra RBC protozoan
febrile hemoltyic anemia tick hemoglobinuria |
tx mild clinda + quinine or atovaquone + azithromycine
severe: exchange transfusion may see emotional lability here |
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Giardia
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SULFURIC BELCHING
FLATULENCE giardia specific Ag on stool tx flagyl |
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eye: ulcerative dendritic keratitis bug?
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herpes
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path/herpes
tx |
multinucleated giant cell
acyclovir if pregnant w active herpes: c section |
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AIDS
CD4< 50 eye bug worry? |
CMV retinitis
floaters see ophthal emergently |
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EBV/AIDS
ent problem? |
hairy leukoplakia of tongue
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Kaposis bug
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Human herpesvirus 8
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rubella sx
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red rash LN behind ear fever
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measles sx
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cough, conj, coryza Koplik spots m/p rash
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Parvovirus B 19 sx
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fifths
sickle cell:transient aplastic anemia polyarthritis of hands/feet/knees dx IgM to parvo |
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recurrent vaginal infections think what bug
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HIV
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recurrent zoster bug to think of
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HIV
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bacterial pneumonia in youong adult
other worries |
hiv
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PCP
tx |
bactrim or pentamidine
ck A-a gradient if <70 add steroids |
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when do you d/c pcp prophylaxis?
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CD4>200 x 3 mo
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PPD for hiv pt when pos
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>5 mm
but neg test does not rule out tb for hiv pt |
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when do you see MAC/MAi in aids pt
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CD4<50
fever sweats, diarrhea, abd pain, HSM dx cx blood, BM, tissue tx biaxin or azithromycin |
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when to start therapy for +HIV
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AIDS-defining infection
CD4<350 pregnant |
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Zidovudine
SEs |
anemia
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ddi/didanosine
SEs |
pancreatitis, p neuropathy
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Lamivudine 3tc
SEs |
pancreatitis
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Abacavir
SE |
hypersensitivity reaction
fever chilss rash flu if has this CAN NEVER HAVE MED AGAIN WILL DIE screen w HLA-B 5701 |
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Efavirenz\
SEs |
cns toxic
teratogenic |
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when prophylaxis for poss HIV exposure
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if the fluid bloody
is skin integrity compromised? tx ZDZ, 3TC, +/- lopinavir/ritonavir x 4 wks |
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major criteria for rheumatic fever
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carditis
polyarthritis chorea erythema marginatum subcutaneous nodules and either + throat or ASO |
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Minor criteria for rheumatic fever
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prev rh fever
arthralgias acute phase react: high esr or wbc ECG-prolonged PR |
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diag of rheumatic fever
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2 major or
1 major and 2 minor and proof of strep--throat or ASO |
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MCC mitral stenosis
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rheumatic fever
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dx meningitis bacterial
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lumbar puncture no imaging unless focal findings
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MCC meningitis
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strep pneumo
N meningitides also cover listeria if older |
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if pt has complement def and meningitis think
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Neisseria
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if pt has meningitis/splenectoy think
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strep pneumo, h flu, n meningitis
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csf bacterial meningitis
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WBC 500-10000
90% neuts low glucose elev protein |
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csr viral meningitis
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WBC 50-500
nl glucose low protein |
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empiric tx of meningitis
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3rd gen ceph + vanco
maybe amp if covering listeria |
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Gm stain LP
gm+ diplococci |
s pneumo
3rd gen ceph + vanco |
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Gm stain LP
Gm-diplococci |
Neisseria
IV PEN or 3rd gen ceph |
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what is MC sequelae of meningitis among survivors?
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deafness
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what to use for prophylaxis for Neisseria
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kids rifampin
pregnant ceftriaxone cipro nonpregnant |
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what bug is assoc w hamsters/meningitis
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lymphocytic choriomeninitis virus
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which virus more likely to see confusion w meningitis
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HSV
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Monarticular arthritis think
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lyme
parvovirus GC |
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tx for gonorrhea
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ceftriaxone or cefixime
spectinomycine |
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PID hosp tx
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cefoxitin + doxy
or clindamycin IV + gent then doxy |
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PID when hosp?
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if surgical emergency can/t be ruled ouot
if pregnant if abscess suspected |
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chlamydia tx
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azithromycin 1 gm or doxy x 7d or quinalone/levo
pregnant azith or amox |
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asx bacteruria
who to treat? |
pregnant
neutropenic diabetics transplants |
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osteomyelitis
acute staph |
IV drugs pseudomonas MRSa
SS pt: salmonella, staph neg bone scan excludes osteomyelitis prosthetic jt; staph epi, chronic do jt aspiration |
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dog bite
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healthy and available for 10d
observation: no prophylaxis unless head/neck bite--then do prophylaxis for rabies |
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plague
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mice/rats, fleas, desert SW
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leptospirosis
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rat urine incubationn 7-12d
outbreaks/triathlons jaundice, renal failure, uveitis dogs can get it/excrete spirochetes CONJUNCTIVAL SUFFUSION" |
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hantavirus
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desert SW
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reptiles
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salmonella
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Ferrets
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campylobacter 18%
also influenza, TB |
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cat bite
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augmentin or clinda/cipro
pasturella ringworm |
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cat scratch
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bartonella
bacillary angiomatosis in AIDS azithromycin don't bx nodes |
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leptospirosis dx
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sepsis phase 4-7d
mild influenza, BC/CSF +org immune phase: +urine cx |
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mycobacterium marinarum
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aquarium
+AFB |
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vibrio
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alcoholic who eats oysters or swims in Gulf of Mexico
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West Nile virus severe sx
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neuro dx
fever wkness MS chg, ataxia, cranial n, myelitis optic neuritis, sz |
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West Nile dx
and labs |
IgM ab ELISA of serum/CSF
labs: WBc nl/mildly elev hyponatremia CSF w elev lymphs, protein, but glucose nl MRI showed enhancment of leptomeninges in 1/3 tx supportive |
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pt from england w ataxia and dementia thinks
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bovine spongiform encephalopathy
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which abtic useful for tularemia
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gent, streptomycin or doxy
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best tx for Q fever
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doxy or tcn
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blastomycosis tx
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itraconazole
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plasmodium falciparum tx
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anything but chloroquine
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obstructed urinary tract/male
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enterococcus--amp + Gm- coverage
if NH cover pseudomonas |
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infected central line abtic?
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vanco if concerned about Gm- cover for psueudomonas
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meningitis tx
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young person rocephin/vanco
for resistant pneumococcus elderly or pregnant above + ampiciliin neonate amp/gent/or amp/cefotaxime |
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Neutropenic fever w Gm- in blood
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pip/taz + AG or quinalone, quinalone + AG
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what abtic binds to the 50s subunit of the bacteria
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emycin
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tx lyme w 3rd deg HB
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pacer/ceftriaxone
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pseudmonas/tobra
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think cystic fibrosis
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what quinalone is effective in anaerobic infections
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moxifloxacin
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quinalones are bactericidal by inhibiting this bacterial replication enzyme
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DNA gyrase and topoisomerase IV
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good choice for osteo and cheap
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cefazolin
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ceph good for pseudomonas
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ceftazidime or cefepime
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prolonged use of any beta lactam may reduce what
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vit K producing bacteria
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tx enterobium vermicularis
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pinworm, NH
mebendazole |
