My Notes For Infectious Disease 1

Front 1

when is bacterial flora increased in amount and variability in the stomach?

Back 1

Absence of gastric acid (achlorhydria)

Front 2

what part of the GI has the highest bacterial load?

Back 2

colon ( about 10^11)

Front 3

How much % are anaerobes in the colon?

Back 3

99%

Front 4

what % does bacteroides fragilis make up in the colonic flora? Significance of bacteroides fragilis in gastrointestinal abscesses

Back 4

0.5% but most common isolate in GI abscesses

Front 5

T/F: Enterobacteriaceae includes E.coli,Klebsiella, Enterobacter,
Salmonella, Serratia, Proteus,

Back 5

T
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)

Front 6

The presence of ascities always precedes peritoneal infection in what % of patients with cirrhosis? What is the route of infection?

Back 6

10% (and it can range from g-, g+,

Usually hematogeous spread of the bacteria to the peritoneal cavity

Front 7

Reasons why patients with cirrhosis and ascitis have Spontaneous bacterial peritonitis?

Back 7

1. Poor removal of bacteria by liver
2. low levels of complement in ascitis
3. Poor function of neutrophils in advanced liver disease.

Front 8

Treatment of Spontaneous bacterial peritonitis?

Back 8

Ampicillin + Gentamicin
Cefotaxime (3rd gen. - anti-enteric)
Ceftriaxone (3rd gen - anti-enteric)

Front 9

Bacterimia present in what % of Spontaneous bacterial peritonitis? Secondary peritonitis(e.g ruptured appendicitis)?

Back 9

1. 75%
2. 20-30%

Front 10

Diverticulitis normally occurs in what population? what is the pain location generally?

Back 10

1. Elderly
2. left lower quandrant (especially due to our low fiber diet)

Front 11

Causes of diverticulitis? Complications of diverticulitis?

Back 11

1. Low fiber diet (low bulk) + increase in intraluminal pressure
2. Perforation, abscess formation and fistulas (fecaluria, pneumaturia)

Front 12

Antibiotics for diverticulitis?

Back 12

Ciprofloxacin (DNA gyrase inhibitor)
Metronidazole

Front 13

90% of proctitis is caused by what bug? what are other causes?

Back 13

1. HSV-2 (herpes simplex virus type 2)
2. Neissria gonnorrhoase, chlamydia, syphillis

Front 14

What promotes abscess formation from an GI infection of bacteroides fragilis?

Back 14

Capsular polysaccaride complex of the bacterium and cell mediated immunity of the host are both required

Front 15

Causes of Impetigo? characteristics?

Back 15

1.Staph aureus and Strep pyogenes
2. Pruritic and painless

Front 16

Cause of folliculitis?

Back 16

Staph
- pustules with red rim with hair in centre

Front 17

Cause of Erysipelas? xteristics? location of infection?

Back 17

1. Group A Strep
2. Increase WBC, fevers,bright red pustule
3. Dermis peripheral spread in lymphatics

Front 18

Causes and location of cellulitis? Si/Sx?

Back 18

1.Staph, Strep, H. Flu, Enterobacteria
2.Deep dermis and subcuta fat
3. Erythema and systemic signs

Front 19

Unusal causes of cellulitis?

Back 19

Anthrax (ulcers)
vibrio vulnificus
etc.

Front 20

Location of necrotizing fascitiis (flesh eating bacterial infection)

Back 20

SubQ fat and fascia (muscle)

Front 21

Types of necrotizing fascitiis?

Back 21

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.

Front 22

What are Fournier gangrene? Ludwig's Angina?

Back 22

1. Necrotizing fasciitis of perineum (Fournier)
2.Necrotizing fasciitis of head and neck (dental source, polymicro, airway edema, obstruction). Ludwig's

Front 23

In Staph Toxic shock syndrome what toxins causes menstrual TSS and what causes non-menstrual?

Back 23

1. 100% - TSS toxin -1 (menstrual)
2. 50% - TSS toxin 1
50% - enterotoxin B and C
(non-menstrual)

Front 24

Mortality rates of Stap TSS in menstrual and non-menstrual?

Back 24

1. 0% (menstrual)
2. 10% (non-menstrual)

Front 25

Toxin invovled in Strep TSS and its mode of action? Therapy? Mortality?

Back 25

1.Strep pyogenic exotoxin as a superantigen. (but blood cultures normally positive as opposed to staph TSS)
2. Penicillin/clindamycin
3. 30%

Front 26

Erythroderma rash is present in Staph or Strep? Bacteremia is present in Staph or Strep?

Back 26

1. Rash (staph)
2. Bacteremia (strep about 60%of cases)

Front 27

Erythroderma rash is present in Staph or Strep? Bacteremia is present in Staph or Strep?

Back 27

1. Rash (staph)
2. Bacteremia (strep about 60%of cases)

Front 28

What are the 3 effective cephalosporins against pseudonomas aeruginosa (g-lac-oxidase+)?

Back 28

The Taz,Fop and Fep all 3rd gen.
1.Ceftazidime
2.Cefoperazone
3.Cefepime

Front 29

Name some Aminoglycoside? mode of Action? why is it great with penicillin?

Back 29

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)

Front 30

What is normal body temperature?

Back 30

37C (36-37.7C) or 98.6F (98.6-99.9F)

Front 31

List a few Endogenous pyrogens?

Back 31

IL 1
IL 6
TNFa
INF gamma

Front 32

list a few Exogenous pyrogens?

Back 32

Cell wall (peptidoglycan, LPS)
Toxins (TSST)
Antigen-Antibody complex
Drugs

Front 33

Why is temperature increased with fever?

Back 33

Due to increased heat conservation (due to change of temp setpoint)

Front 34

What drugs reduce the hypothalamic temp set point?

Back 34

Acetominophen and aspirin

Front 35

Causes of Hyperprexia (T>41.5C)?

Back 35

1. CNS hemmorrhage
2. Drugs
3. Severe infection

Front 36

By how much % does O2 consumption increase by every 1oC above 37oC?

Back 36

13%

Front 37

Why do people on corticosteroid don't get a fever?

Back 37

because it reduces PGE2 synthesis and block transcription of mRNA for pyogenic cytokines e.g IL 1

Front 38

List the types of FUO (Fever of unknown origin)?

Back 38

1. Classic FUO
2. Nosocomial FUO (e.g Catheter related -staph aureus, staph epidermis)
3. Immunne-deficient FUO
4. HIV associated FUO

Front 39

Some Classification of fever

Back 39

Fever with
1. Rash
2. Lymphadenopathy - regional or diffuse
3.temperature - pulse dissociation

Front 40

Diagnostic categories and % they contribute to fever.

Back 40

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

Front 41

Definition of classic Fever of unknown origin?

Back 41

>38oC For
1. >3 weeks
2. >2 visits
3. 3days in hospital

Front 42

Definition of nosocomial Fever of unknown origin?

Back 42

>38oC For
1.3days not present on admission

Front 43

Definition of Immune-deficient Fever of unknown origin?

Back 43

>38oC For
1.>3days with negative cultures after 48hrs.

Front 44

Definition of HIV-related Fever of unknown origin?

Back 44

HIV infection is confirmed.
>38oC For
1. >3weeks (aa outpatient)
2. >3days (inpatients)

Front 45

Which of the types of Fever of unknown origin would you have the quickest tempo of investigation?

Back 45

Immune-deficient Fever of unknown origin

Front 46

UTI Risk factors in Children? young women? young men? older age?

Back 46

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

Front 47

Most common cause of uncomplicated UTI?

Back 47

uropathogenic E-coli (80%)
others : GNB, staph saprophyticus (common)

Front 48

What bacteria is a common cause of Nephrolithiasis?

Back 48

Proteus . Its a g-lac-oxi- bac that alkalizes the urine.

Front 49

Causes of complicated UTI?

Back 49

GNB's, pseudomonas (g-lac-oxi+), serratia (g-lac+slow)

Front 50

What conditions may lead to a complicated UTI?

Back 50

Obstructive disease, diabetes, pregnancy,Cancer - anything that predisposes an individual an infection

Front 51

Do you normally have fever in cystitis? what are the other Si/Sx of cystitis?

Back 51

1. No
2. Dysuria, Frequency, incontinence, urgency

Front 52

What are specific Si/Sx of polynephritis?DDx in women

Back 52

1. Fever and flank pain.
2. PID (pelvic inflammatory disease)

Front 53

What are the 2 routes of renal and perinephric abscess?

Back 53

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)