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101 Cards in this Set
- Front
- Back
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strep appearance
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gram pos cocci in chains
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staph appearance
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gram pos cocci in clusters
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strep pneumo appearance
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gram pos cocci in pairs (diplococci)
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H flu appearance
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gram neg small rods
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Neisseria/Moraxella appearance
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gram neg diplococci
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kleb appearance
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gram neg rod plump with thick capsule
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clostridium, bacillus appearance
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gram positive spore forming rods
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candida appearance
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pseudohyphae
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M.tuberculosis, Nocardia appearance
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acid fast
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Actinomyces appearance
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gram pos with sulfur granules
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Pneumocystis jiroveci and cat scratch appearance
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silver staining
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cryptococcus appearance
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positive india ink prep with thick capsule
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Treponema, Leptospira, Borrelia appearance
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spirochete
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gardener stuck by thorn
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Sporothrix schenckii: tx with itraconazole, fluconazole, or oral potassium iodide
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aplastic crisis in sicklers or other hemoglobinopathy
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Parvovirus B19
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sepsis after splenectomy or autosplenectomy in sicklers
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encapsulated bugs: strep pneumo, H flu, N meningitidis
Some Killers Have Pretty Nice Capsules Strep, Kleb, Hemophilus, Proteus, Nisseria, Cryptococcus |
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pna in the sw
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Coccidioides immitis: tx with itraconazole, fluconazole, amphoB for severe
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spelunker pna or after exposure to bird droppings in Ohio and Mississippi river valleys
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Histoplasma capsulatum
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pna after exposure to exotic bird
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Chlamydia psittaci tx with tetracycline or macrolides
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fungus ball/hemoptysis after TB induced cavitary dz
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Aspergillus
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pna in pt with silicosis
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TB
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diarrhea after drinking from a stream
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Giardia lamblia: tx with metro
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Preg women with cats
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Toxo: treat HIVs with Pyrimethamine and Sulfadiazine or clinda or spiramycin for pregs. For latent infections Atovaquone or Clinda
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B12 def and abdominal sxs
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D latum
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seizures after ring enhancing lesions on CT
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Taenia solium (neurocysticercosis): tx with PZQ
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squamous cell bladder cancer in middle east and africa
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Schistosoma haematobium: tx with PZQ
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worm infection in children
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Enterobius (pinworms) use albendazole or pyrantel pamoate
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fever, muscle pain, eosinophilia, and periorbital edema after eating raw meat
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Trichinella spiralis (trichinosis): tx with Albendzole
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Gastro in young children
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rotavirus
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reheated rice
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Bacillus cereus
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raw seafood
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Vibrio parahaemolyticus
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diarrhea after traveling to Mexico
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EC
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diarrhea after abx
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CDiff tx with oral Metro or Vanco
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paralyzed after eating honey
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Clostridium botulinum: tx with BABYBIG
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genital lesions in children w/o sexual abuse/activity
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molluscum contagiosum (Poxvirus)
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cellulitis after cat/dog bites
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Pasteurella multocida: treat/proph with ampicillin
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slaughterhouse worker with fever
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Brucella
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pna after hotel, near ac, or water tower
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Legionella pneumophila, tx with Azithro or FQ
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burn wound with blue/green color
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pseudomonas
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bug and empiric tx for Bronchitis
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viral, H flu, Moraxella
Amox, Erythro |
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bug and empiric tx for cellulitis
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strep, staph
antistaph pcn: diclox, methicillin, Nafcillin |
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bug and empiric tx for endocarditis
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staph, strep
antistaph pcn (or vanco) + aminoglycoside |
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bug and empiric tx for meningitis child and adult
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strep pneumo, N meningitidis
3rd gen ceph/Meropenem + Vanco |
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neonatal meningitis
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GBS, EC, Listeria
Ampicillin + AG, 3rd gen ceph |
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Osteomyelitis
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Staph aureus, Salmonella
Antistaph pen, vanco |
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table 10-1
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memorize
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table 10-2
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memorize
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appearance of c diff on colonoscopy
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pseudomembranes (light colored 3-10 mm plaques scattered about mucosa)
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gold standard for pna diag
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sputum culture and blood cultures
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what about strep pneumo pna
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most common esp in older adults, uri then chills, then fever, pleurisy, prod cough
XR shows lobar consolidation high WBC with many neutros tx with 3rd gen ceph or FQ |
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who do we vacc against strep pneumo pna
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children, older than 65, immunocomp, sicklers, splenectomized, chronic dz pts
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what about hflu pna
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2nd most common cause of pna
more common in young children looks like strep pneumo clinically tx with amp/amox, 2nd or 3rd gen ceph if gram neg coccobacilli seen on gram stain |
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what about staph pna
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in hospital acquired and second to pseudomonas in CFers
also IVDA, chronic granulomatous dz (recurrent lung abscesses) empyema and lung abscesses common also effusions |
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what about gram neg pna
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Pseudomonas with CFers
Kleb in alcoholics and homeless EC with aspiration, neutropenia, hospital acquired gram negs commonly have effusions/abscesses tx with 3rd gen pcn/ceph + AG |
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what about mycoplasma pna
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most common in adolescents and young adults
long prodrome, gradual worsening of HA, malaise, dry nonprod cough, sore throat CXR worse than sxs Look for positive cold agglutinin abs which can cause hemolysis and anemia Tx with Macrolide (Azithro) |
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what about Chlamydia pna
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second to mycoplasma in young adults pna, neg cold agglutinin abs
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what about viral pna
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RSV, flu, paraflu, adeno
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what about PCP/CMV pna
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HIV pts
treat PCP with bactrim, alt is pentamidine PCP when CD4 <200 at which point you start PCP proph with bactrim CMV has intracellular inclusion bodies, tx with ganciclovir or foscarnet |
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what about syphilis
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bug: T pallidum
drug: PCN, doxy if allergic can seen on dark field but not gram stain screen all preg with RPR/VDRL three stages: 1. primary: painless chancre that resolves in 8 wks 2. secondary: 6wks to 18mo condyloma lata, maculopapular rash of palms and soles, LAD 3. tertiary: years after untreated infection: gummas in different organs, neurosyphilis, Argyll Robertson pupil, demential, paresis, tabes dorsalis, Charcot joints, aortic aneurysms remember false pos RPR/VDRL in lupus |
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what about chickenpox (varicella)
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truncal macules to papules to vesicles that rupture and crust all in a day
rashes are in different stages in different areas infectious until last rash crusts over can see on Tzank smear multinucleated giant cells immunize in leukemics, AIDS, newborns of mothers with chickenpox Varicella zoster can reactivate years later to cause shingles: dermatomal dist of rash with pain and paresthesias never give ASA to a child with fever |
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what about erythema infectiosum
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aka Fifth's dz caused by ParvoB19
"slapped cheek" rash and constitutional sxs 1 day later maculopapular rash on arms, legs, trunk |
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what about impetigo
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history of skin break, weeping vesicles with yellowish crust
since it's infetious tx with antistaph PCN to cover strep and staph |
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what about mono
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EBV: fatigue, fever, LAD, pharyngitis
diff from strep pharyngitis b/c of prolonged malaise, h-s megaly, lymphocytosis, anemia, thrombocytopenia, positive monospot test avoid contact sports and heavy lifitng in case of splenic rupture Assoc with nasopharyngeal cancer and African Burkitt's lymphoma |
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what about Measles
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aka rubeola, look for a reason for not immunization
Koplik's spots seen 3 days post high fever cough, runny nose, conjunctivitis, photophobia cephalocaudal progressing maculopapular rash |
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what about rickettsia
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tick bite 1 week before fever, chills, HA, prostration, severe malaise
then 4 days after sxs started inwardly spreading rash on palms and soles and periungual desquamation complications: DIC, delirium Tx: doxy, chloramphenicol |
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what about Roseola infantium
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high fever for 4 days
abrupt return to normal temp as diffuse maculopapular rash on chest and abd rare in children older than 3 HHV6 Tx; fluids, tylenol |
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what about Rubella
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aka German measles
screen and immunize and woman of repro age before pregnancy vaccine contraindicated during preg 2 day prodrome: low grade fever, malaise, tender swelling of suboccipital and postauricular nodes arthralgia then, cephalocaudal progressing MP rash comp: encephalitis and otitis media |
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what about scarlet fever
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hx of untreated GAS strep pharyngitis, fever, then sandpaper rash on trunk with circumoral pallor and strawberry tongue
rash desquamates when fever subsides Tx with PCN |
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endocarditis sxs
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FROM JANE
Fever Roth spots Osler's nodes Murmur Janeway lesions Anemia Nail bed hemorrhage Emboli |
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Endocarditis bugs
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Acute: Staph aureus
Subacute: Strep viridans Culture neg: HACEK Hemophilus Actinobacillus Cardiobacterium Eikenella Kingella |
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Endocarditis complications
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chordae rupture, GN, suppurative pericarditis, emboli
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Endocarditis tx
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3rd gen PCN or Ceph plus aminoglycoside
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Meningitis bugs for 0-6 mo
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GBS, EC, Listeria
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Meningitis bugs for 6mo to 6y
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Strep pneumo, Neisseria, Hflu typeB, Enterovirus
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Meningitis bugs 6-60y
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Strep pneumo, Neisseria, Enteroviruses, HSV
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Meningitis bugs 60+
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Strep pneumo, GNRs, Listeria
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Meningitis bugs in HIV
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Cryptococcus, CMV, Toxo, JC virus
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Meningitis sxs
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Kernig's and Brudzinski signs
lethargy, hyper or hypothermia, poor tone, bulging fontanelle, vomiting, photophobia, AMS, signs of sepsis, seizures |
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most common neuro sequela of meningitis
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hearing loss
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what do you look for in a baby if mom has HSV lesions at birth
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temporal lobe abnormalities on CT/MRI. Give acyclovir
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causes of aseptic meningitis
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mumps, measles if unvaccinated
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if meningitis is due to Neisseria, what do you give contacts
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cipro or Ceft, or rifampin as proph
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3 most common types of peds resp infections
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croup, epiglottitis, bronchiolitis
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what about bronchiolitis
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0-18 mo old, fall or winter
bugs: RSV, paraflu, flu sxs: uri sxs then 1-2 d later rapid resp, intercostal retractions, exp wheezing, crackles on auscultation CXR shows diffuse hyperinflation with flattened diaphragm Tx with O2, mist tent, bronchodilators, IVF, ribavarin if sxs severe |
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what about croup or acute laryngotracheitis
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1-2 y old, fall/winter, paraflu/flu
start with a viral URI then 1-2 d later barking cough, hoarseness, insp stridor Steeple sign on CXR tx: racemic epi |
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what about epiglottitis
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2-5 y, Hflu type B / Staph aureus
little/no prodrome high fever, drooling, resp dist, no coughing thumb sign on lateral neck XR don't irritate the pt tx: ceftriaxone and be ready to est airway |
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what about diphtheria and pertussis
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Corynebacterium diphtheria: grayish pseudomembranes on pharynx/tonsils/uvula/myocarditis
Bordetella pertussis: severe paroxysmal coughing and high pitched whooping inspiratory noise tx both with abx and antitoxin for diphtheria |
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common rabies animals
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bats, skunks, racoons, foxes
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what about rabies
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incubation period 1-2 months, sxs: hydrophobia, CNS signs
1. cleanse with soap, don't close 2. observe/kill animal/tissue 3. prophylax with Ig and vaccine if animal has rabies, if wild animal escapes, or if unprovoked attack from dog/cat 4. do not give prophylaxis for bites by rodents |
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what does E faecalis cause
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endocarditis, UTI, sepsis
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what does Strep agalactiae cause?
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GBS: neonatal meningitis/sepsis
Tx: amox, amp |
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what does strep pneumo cause
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pna, otitis media, meningitis, sinusitis, sepsis
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what about GAS
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Strep pyogenes: pharyngitis: sore throat, fever, exudate, LAD, WBCs. Dx with rapid strep test, avoid treating without confirmation of diagnosis. ASLO and anti DNAse titers used retrospectively. Tx with PCN to avoid rh fever and scarlet fever
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what about Rh fever
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Jones criteria
JONES PEACE and history of strep pharyngitis Tx with ASA, steroids for severe carditis |
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what about scarlet fever
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GAS pharyngitis untreate progresses to scarlet fever if erythrogenic toxin produced. red blanching flush in skin, circumoral pallor, truncal rash, strawberry tongue, late skin desquamation. Looks like kawasaki's
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what about PSGN
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most commonly after GAS skin infection, but can occur after pharyngitis. strep infection 1-3 wks prior, onset of hematuria, proteinuria, RBC casts, HTN, edema esp periorbital, high BUN and creatitine
Tx: supportive: control BP and use diuretics for severe edema PSGN can't be prevented with treatment of GAS infections with abx |
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what about impetigo
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usually staph more than strep
staph is furuncle or carbuncle is present strep is PSGN is present watch for sick contacts treat with antistaph PCN like dicloxacillin |
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what about erysipelas
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superficial cellulitis: red shiny swollen tender
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what about cellulitis
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deeper than erysipelas, strep most common
tx with antistaph PCN or vanco suspect pseudomonas if diabetic ulcer, burns, trauma, tx with broad spec PCN plus AG if Pasteurella multocida (dog or cat bite) then tx with IV Ampicillin if Vibrio vulnificus (fisherman/saltwater exposure) then tx with Tetracycline |
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what about nec fas
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look for necrosis, gangrene, crepitus, systemic toxicity
Tx: IVF, I&D, broad spec abx (broad spec PCN, ceph plus AG) |
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what about endometritis or puerperal fever
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endometritis is postdelivery fever and uterine tenderness. Tx with amox or amp
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