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53 Cards in this Set

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  • Back
when is bacterial flora increased in amount and variability in the stomach?
Absence of gastric acid (achlorhydria)
what part of the GI has the highest bacterial load?
colon ( about 10^11)
How much % are anaerobes in the colon?
what % does bacteroides fragilis make up in the colonic flora? Significance of bacteroides fragilis in gastrointestinal abscesses
0.5% but most common isolate in GI abscesses
T/F: Enterobacteriaceae includes E.coli,Klebsiella, Enterobacter,
Salmonella, Serratia, Proteus,
First 3 are lactose fermentors
2nd 3 are lactose non fermentors(but oxidase negative)

so all are oxidase negative (for oxidase postive in g- bacteria think pseudonomas)
The presence of ascities always precedes peritoneal infection in what % of patients with cirrhosis? What is the route of infection?
10% (and it can range from g-, g+,

Usually hematogeous spread of the bacteria to the peritoneal cavity
Reasons why patients with cirrhosis and ascitis have Spontaneous bacterial peritonitis?
1. Poor removal of bacteria by liver
2. low levels of complement in ascitis
3. Poor function of neutrophils in advanced liver disease.
Treatment of Spontaneous bacterial peritonitis?
Ampicillin + Gentamicin
Cefotaxime (3rd gen. - anti-enteric)
Ceftriaxone (3rd gen - anti-enteric)
Bacterimia present in what % of Spontaneous bacterial peritonitis? Secondary peritonitis(e.g ruptured appendicitis)?
1. 75%
2. 20-30%
Diverticulitis normally occurs in what population? what is the pain location generally?
1. Elderly
2. left lower quandrant (especially due to our low fiber diet)
Causes of diverticulitis? Complications of diverticulitis?
1. Low fiber diet (low bulk) + increase in intraluminal pressure
2. Perforation, abscess formation and fistulas (fecaluria, pneumaturia)
Antibiotics for diverticulitis?
Ciprofloxacin (DNA gyrase inhibitor)
90% of proctitis is caused by what bug? what are other causes?
1. HSV-2 (herpes simplex virus type 2)
2. Neissria gonnorrhoase, chlamydia, syphillis
What promotes abscess formation from an GI infection of bacteroides fragilis?
Capsular polysaccaride complex of the bacterium and cell mediated immunity of the host are both required
Causes of Impetigo? characteristics?
1.Staph aureus and Strep pyogenes
2. Pruritic and painless
Cause of folliculitis?
- pustules with red rim with hair in centre
Cause of Erysipelas? xteristics? location of infection?
1. Group A Strep
2. Increase WBC, fevers,bright red pustule
3. Dermis peripheral spread in lymphatics
Causes and location of cellulitis? Si/Sx?
1.Staph, Strep, H. Flu, Enterobacteria
2.Deep dermis and subcuta fat
3. Erythema and systemic signs
Unusal causes of cellulitis?
Anthrax (ulcers)
vibrio vulnificus
Location of necrotizing fascitiis (flesh eating bacterial infection)
SubQ fat and fascia (muscle)
Types of necrotizing fascitiis?
Type 1 (anaerobes, facul.aerobes)
Type 2 (staph and strep)
Clostridial myonecrosis (clostridium)

Type 1 and Clostridial myonecrosis present with tissue gas and foul smell(esp in type1), muscle involvement.All these not found in type2.
What are Fournier gangrene? Ludwig's Angina?
1. Necrotizing fasciitis of perineum (Fournier)
2.Necrotizing fasciitis of head and neck (dental source, polymicro, airway edema, obstruction). Ludwig's
In Staph Toxic shock syndrome what toxins causes menstrual TSS and what causes non-menstrual?
1. 100% - TSS toxin -1 (menstrual)
2. 50% - TSS toxin 1
50% - enterotoxin B and C
Mortality rates of Stap TSS in menstrual and non-menstrual?
1. 0% (menstrual)
2. 10% (non-menstrual)
Toxin invovled in Strep TSS and its mode of action? Therapy? Mortality?
1.Strep pyogenic exotoxin as a superantigen. (but blood cultures normally positive as opposed to staph TSS)
2. Penicillin/clindamycin
3. 30%
Erythroderma rash is present in Staph or Strep? Bacteremia is present in Staph or Strep?
1. Rash (staph)
2. Bacteremia (strep about 60%of cases)
Erythroderma rash is present in Staph or Strep? Bacteremia is present in Staph or Strep?
1. Rash (staph)
2. Bacteremia (strep about 60%of cases)
What are the 3 effective cephalosporins against pseudonomas aeruginosa (g-lac-oxidase+)?
The Taz,Fop and Fep all 3rd gen.
Name some Aminoglycoside? mode of Action? why is it great with penicillin?
1. Streptomycin, Gentamycin, Neomycin, Tobramycin, Amikacin
(end with mycin)
2. Aerobic g- organism (needs O2 to work). Inhibits 30S ribosome
3. Diffuses in cell wall (great with penicillin)
What is normal body temperature?
37C (36-37.7C) or 98.6F (98.6-99.9F)
List a few Endogenous pyrogens?
IL 1
IL 6
INF gamma
list a few Exogenous pyrogens?
Cell wall (peptidoglycan, LPS)
Toxins (TSST)
Antigen-Antibody complex
Why is temperature increased with fever?
Due to increased heat conservation (due to change of temp setpoint)
What drugs reduce the hypothalamic temp set point?
Acetominophen and aspirin
Causes of Hyperprexia (T>41.5C)?
1. CNS hemmorrhage
2. Drugs
3. Severe infection
By how much % does O2 consumption increase by every 1oC above 37oC?
Why do people on corticosteroid don't get a fever?
because it reduces PGE2 synthesis and block transcription of mRNA for pyogenic cytokines e.g IL 1
List the types of FUO (Fever of unknown origin)?
1. Classic FUO
2. Nosocomial FUO (e.g Catheter related -staph aureus, staph epidermis)
3. Immunne-deficient FUO
4. HIV associated FUO
Some Classification of fever
Fever with
1. Rash
2. Lymphadenopathy - regional or diffuse
3.temperature - pulse dissociation
Diagnostic categories and % they contribute to fever.
1. Infection (30-40%): can be systemic(malaria) or localized (e.g abscesses,otitis)
2 Neoplasm (20-30%)- Lymphoma
3.Collagen-Vascular disease (10-20%) -RA, SLE, Temporal arteritis
4. miscellaneous (15-20%) - drug,factitious, alchoholic fever
Definition of classic Fever of unknown origin?
>38oC For
1. >3 weeks
2. >2 visits
3. 3days in hospital
Definition of nosocomial Fever of unknown origin?
>38oC For
1.3days not present on admission
Definition of Immune-deficient Fever of unknown origin?
>38oC For
1.>3days with negative cultures after 48hrs.
Definition of HIV-related Fever of unknown origin?
HIV infection is confirmed.
>38oC For
1. >3weeks (aa outpatient)
2. >3days (inpatients)
Which of the types of Fever of unknown origin would you have the quickest tempo of investigation?
Immune-deficient Fever of unknown origin
UTI Risk factors in Children? young women? young men? older age?
Children - congenital abnomalities, versicoureteral reflux
young women- (50x>men)- short urethra, sexual intercourse,spermicide
men- homosexuality,HIV, uncircumcised
Older age - BPH, post-meno, catheterization,surgery
Most common cause of uncomplicated UTI?
uropathogenic E-coli (80%)
others : GNB, staph saprophyticus (common)
What bacteria is a common cause of Nephrolithiasis?
Proteus . Its a g-lac-oxi- bac that alkalizes the urine.
Causes of complicated UTI?
GNB's, pseudomonas (g-lac-oxi+), serratia (g-lac+slow)
What conditions may lead to a complicated UTI?
Obstructive disease, diabetes, pregnancy,Cancer - anything that predisposes an individual an infection
Do you normally have fever in cystitis? what are the other Si/Sx of cystitis?
1. No
2. Dysuria, Frequency, incontinence, urgency
What are specific Si/Sx of polynephritis?DDx in women
1. Fever and flank pain.
2. PID (pelvic inflammatory disease)
What are the 2 routes of renal and perinephric abscess?
1. Ascending with obstruction
2. Hematogenous

needs to be drained, <3cm usu. responds to Abx alone.
lack of response or >5cm will need intervention (surgical)